Complete information (name, DOB etc.). 2. Indicate which vaccine(s) the medical exemption is referring to. 3.Show proof of their child's up-to-date vaccinations, OR; Provide a valid medical exemption from vaccination. The request for exemption must be typed or hand-written in the appropriate boxes on this form. All of the immunization requirements. A physician must sign an exemption form indicating the vaccines that are included in the medical exemption. No information is available for this page. I wish to obtain an Exemption from Immunizations for Reasons of Conscience Affidavit Form.

Exempt Form For Immunizations In Nassau

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