Vaccination laws are very state specific. This form is a generic example that may be referred to when preparing such a form for your particular state. It is for illustrative purposes only. Local laws should be consulted to determine any specific requirements for such a form in a particular jurisdiction.
Vaccine Refusal Form
Category:
State:
Multi-State
Control #:
US-02738BG
Format:
Word;
Rich Text
Instant download
Description Vaccine Refusal Waiver
How to fill out Letter Refusing Vaccine?
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Vaccine Refusal Document Form popularity
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The name of the vaccine and the manufacturer; The lot number and expiration date of the vaccine; The date of administration; The name, address, title and signature (electronic is acceptable) of the person administering the vaccine;
Talk to their doctor or read about the benefits of vaccines and the risks of not vaccinating their children. Get a signature from a local health department official. Write a letter that explains their reasons for refusing vaccines. Renew their exemption form every year.
What should you do if your child misses a shot? For most vaccines, it is never too late to catch up on missed shots. Children who missed their first shots at 2 months of age can start later. Children who have received some of their shots and then fallen behind schedule can catch up without having to start over.
Parents of children enrolling in primary or secondary schools must be asked for an approved immunisation certificate, but if this is not available, the student may still be enrolled, subject to required procedures (e.g. unvaccinated children may be excluded from school for the duration of an outbreak of a vaccine-
