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Vaccine Exempt Form, form, plus example of what can be written to help get children into school who have not had their vaccinations.
Vaccine Exemption
 Printable
Version (by permission only)
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Exemption to Immunization
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| Name ________________________________________ Birthdate ________________________
Address ______________________________________ Parent/Guardian ____________________
_____________________________________________ Telephone _______________________
Please Circle Present Grade: K 1 2
3 4 5 6 7
8 9 10 11 12
Sp. Ed.
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STATEMENT OF EXEMPTION TO IMMUNIZATION LAW
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MEDICAL EXEMPTION
The physical condition of the above named child is such that immunization
would endanger life or health.
Signed _________________________________________________ Date __________________
(Physician)
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RELIGIOUS EXEMPTION
(Includes a strong moral or ethical conviction similar to a religious
belief.)
Parent or guardian of the above named child adheres to a religious belief
whose teachings are opposed to such immunizations.
State your reason for requesting a religious exemption _____________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Signed __________________________________________________ Date _________________
(Parent or Guardian)
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Example of what can be reason for requesting a religious exemption that someone
has used.
WE BELIEVE AS PARENTS WE ARE TOTALLY RESPONSIBLE FOR OUR CHILD UNTIL THEY BECOME
OF AGE. WE ARE VERY APPRECIATIVE OF THE FACT THE US GIVES US FREEDOM OF
CHOICE IN WORSHIP - IMMUNIZATIONS AND MORE. THIS DOES NOT MEAN THAT WE
DO NOTHING - IT MEANS WE USE ALTERNATIVE METHODS TO MAINTAIN HEALTH. UNLIKE
MEDICAL REMEDIES, WHICH HAVE DETRIMENTAL SIDE-EFFECTS, MEGA-NUTRITIONAL SUPPORT
POSES NO SUCH THREAT.
The focus of this site is to "educate,
validate, and suggest alternative methods for the treatment of health conditions,"
which are not readily available to those who go through mainstream programs.
To help ensure good results, high quality
foods and supplements are vital. Knowing
that the cost of supplements can get overwhelming, we provide a wholesale store.
This is a courtesy, not a requirement for you
to ask your questions. We are here to help people, not just gain customers.
If you have any questions please feel free
to contact me.
***When working with natural health it is
beneficial that you have an understanding
of the signs of a healing body. ***
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