Official vaccine exemption forms by state and province

Medical Available

Submit completed form signed by a licensed physician (MD/DO) to the school or childcare facility.

Signed by: Licensed physician (MD or DO)
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

ADPH ImmPRINT guide: Certificate of Medical Exemption (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian submits a written objection based on religious tenets and practices, in person, to the County Health Department and receives education on the consequences of not immunizing. The County Health Department issues a Certificate of Religious Exemption, which goes to the school. Ask the county health department what the visit involves and whether any fee applies.

Signed by: Parent/guardian or individual (age 19+)
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Ala. Admin. Code r. 420-6-1-.02 (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit form signed by a licensed physician (MD/DO), advanced practice registered nurse, or physician assistant to the school.

Signed by: MD, DO, APRN, or PA
Renewal: Duration specified by the healthcare provider.

State of Alaska Medical Exemption / Immunity Form (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian must sign and submit the official state form. Notarization required.

Signed by: Parent/guardian
Renewal: Must be renewed every year; a form is valid July 1 through June 30.

State of Alaska Child Care & School Immunization Requirements packet (contains Religious Exemption Form) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit the ADHS medical exemption form, completed and signed by a licensed physician or registered nurse practitioner and also signed by the parent/guardian, to the school administrator or child care facility.

Signed by: Licensed physician (MD/DO) or nurse practitioner
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

ADHS Medical Exemption Form (opens in a new tab)

Link verified on 2026-11-01

Religious Available

For child care, preschool, and Head Start programs only. Parent/guardian signs and submits the Religious Beliefs Exemption form to the program. No notarization required. This form is not used for kindergarten through 12th grade, where the Personal Beliefs Exemption form applies.

Signed by: Parent/guardian
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

ADHS Religious Beliefs Exemption Form (opens in a new tab)

Link verified on 2026-11-01

Personal belief Available

For kindergarten through 12th grade only. Parent/guardian signs and submits the Personal Beliefs Exemption form to the school. No notarization or explanation of beliefs required. This form does not cover child care or preschool.

Signed by: Parent/guardian
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

ADHS Personal Beliefs Exemption Form (opens in a new tab)

Link verified on 2026-11-01

Medical Available

Parent/guardian completes the Arkansas Immunization Exemption Application with a notarized signature, attaches a physician's letter stating the medical reason, and submits it to the Arkansas Department of Health (ADH). The ADH Medical Director decides the request. After approval, the parent/guardian notifies the school.

Signed by: Arkansas Department of Health Medical Director
Renewal: Application must be submitted each school year. For 2026-2027, approved exemptions run from the start of the fall 2026 session through the summer sessions of 2027.

2026-2027 Arkansas Immunization Exemption Application Packet (Childcare or Pre-K - 12th Grade) (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian completes the Arkansas Immunization Exemption Application with a notarized signature, completes the required educational activity (reading the enclosed Vaccine Information Statements) and submits the application to the Arkansas Department of Health (ADH). After approval, the parent/guardian notifies the school.

Signed by: Arkansas Department of Health
Renewal: Application must be submitted each school year. For 2026-2027, approved exemptions run from the start of the fall 2026 session through the summer sessions of 2027.

2026-2027 Arkansas Immunization Exemption Application Packet (Childcare or Pre-K - 12th Grade) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Available

Parent/guardian completes the Arkansas Immunization Exemption Application with a notarized signature, completes the required educational activity (reading the enclosed Vaccine Information Statements) and submits the application to the Arkansas Department of Health (ADH). After approval, the parent/guardian notifies the school.

Signed by: Arkansas Department of Health
Renewal: Application must be submitted each school year. For 2026-2027, approved exemptions run from the start of the fall 2026 session through the summer sessions of 2027.

2026-2027 Arkansas Immunization Exemption Application Packet (Childcare or Pre-K - 12th Grade) (opens in a new tab)

Link verified on 2026-11-01

Medical Available

A physician must issue the exemption through the California Immunization Registry - Medical Exemption website (CAIR-ME). A parent can create a CAIR-ME account, apply, and give the application number to the physician. The physician prints the issued form and gives the parent a copy for the school. CDPH reviews exemptions when a school's or child care facility's immunization rate falls below 95%, when it fails to report vaccination rates, when a doctor writes 5 or more medical exemptions per year, or when review is necessary to protect public health.

Signed by: Physician (MD or DO) licensed in California. CDPH may review; only the State Public Health Officer or a physician they designate can revoke.
Renewal: Expires at the earliest of: enrollment in the next grade span (TK/K-6th grade, 7th-12th grade), the expiration date of a temporary exemption, or permanent revocation.

CDPH CAIR-ME medical exemption website (opens in a new tab)

Link verified on 2026-11-01

Religious Not available

Personal belief Not available

Medical Available

Submit form signed by a licensed physician (MD/DO), advanced practice nurse, or physician assistant to the school.

Signed by: MD, DO, APRN, or PA
Renewal: Permanent conditions: submitted once, with no annual renewal. Temporary conditions: ends on the "temporary until" date the provider sets.

I want to obtain a Certificate of Medical Exemption (CDPHE) (opens in a new tab)

Religious Available

Parent/guardian must submit the non-medical exemption form. Requires either a signature from a healthcare provider who has provided vaccine education OR an online education module completion certificate.

Signed by: Parent/guardian with provider signature or education module completion
Renewal: New certificate every school year for K-12; it expires June 30. Before kindergarten it must be resubmitted each time vaccines are due.

Nonmedical Exemption (CDPHE) (opens in a new tab)

Personal belief Available

Same process as religious exemption. Colorado uses a unified non-medical exemption form.

Signed by: Parent/guardian with provider signature or education module completion
Renewal: New certificate every school year for K-12; it expires June 30. Before kindergarten it must be resubmitted each time vaccines are due.

Nonmedical Exemption (CDPHE) (opens in a new tab)

Medical Available

A licensed physician (MD/DO), APRN or PA completes and signs the Student Medical Exemption Certificate and enters it in the Department of Public Health Medical Exemptions portal. The school must also receive a copy.

Signed by: MD, DO, APRN, or PA
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

CT DPH Student Medical Exemption Certificate (sample, version 10/03/2024) (opens in a new tab)

Link verified on 2026-11-01

Religious Not available

Personal belief Not available

Medical Available

Submit form completed by a licensed physician (MD/DO) to the school. Sources differ on whether other clinicians may sign, so a licensed physician's signature is the safest choice. Confirm with the Delaware Division of Public Health or the school nurse before using another clinician. Also ask whether the child's condition needs the Supplemental form and Division of Public Health approval.

Signed by: Licensed physician (MD or DO); confirm before using another clinician
Renewal: Temporary: valid for the school year, then resubmitted. Permanent: valid while the child is enrolled, though the school nurse reviews it yearly and may ask for an updated form.

School Vaccination Medical Exemption Form (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian must sign and notarize the religious exemption affidavit and submit to the school.

Signed by: Parent/guardian (with notarization)
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Affidavit of Religious Belief (notarized) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit the DC Universal Health Certificate with the medical exemption section completed and signed by the child's physician or nurse practitioner (or their representative) to the school.

Signed by: Physician or nurse practitioner (or their representative)
Renewal: A permanent medical exemption does not expire. A temporary one lasts until the date the provider gives. The Universal Health Certificate is still returned to the school every year.

DC Universal Health Certificate (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian completes the form and submits to school. Notarization not required.

Signed by: Parent/guardian
Renewal: Annually. A new certificate is needed before each school year; it is valid July 1 to June 30.

Annual Immunization Religious Exemption Certificate (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Physician completes Section C of the DH 680 form waiving specific vaccines. Submit to the school or childcare facility. Florida's Department of Health has proposed changes to Rule 64D-3.046, including new form numbers. Confirm the current form with your county health department before filing.

Signed by: Licensed physician (MD or DO)
Renewal: Per physician's determination.

Florida DOH Immunization Exemptions (Form DH 680) (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian must request and complete form DH 681 from the County Health Department. No notarization required. Florida's Department of Health has proposed changes to Rule 64D-3.046, including new form numbers. Confirm the current form with your county health department before filing. Also confirm the current wording of the religious exemption with the county health department.

Signed by: County Health Department issues the form; parent/guardian signs
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Florida DOH Immunization Exemptions (Form DH 681) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit form completed by a licensed physician (MD/DO) to the school on the Georgia Certificate of Immunization (Form 3231).

Signed by: Licensed physician (MD or DO)
Renewal: Valid for one year. May be reissued each year until the physician determines the immunization can be given safely.

Policy Guide 3231INS: Standards for Certificates of Immunization (Form 3231) (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian must sign and notarize the affidavit and submit it to the school.

Signed by: Parent/guardian (with notarization)
Renewal: Does not expire. A notarized affidavit (DPH Form 2208) stays on file and does not need annual renewal.

Affidavit of Religious Objection to Immunization (DPH Form 2208) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit form signed by a licensed physician (MD/DO), APRN, or PA to the school.

Signed by: MD, DO, APRN, or PA
Renewal: Duration determined by the healthcare provider.

School Health Requirements FAQs (Hawaii DOH) (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian signs the form and submits to the school. Notarization not required.

Signed by: Parent/guardian
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

School Health Requirements FAQs (Hawaii DOH) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit a signed statement from a licensed physician indicating the medical contraindication to the school. Sources differ on whether other clinicians may sign, so a licensed physician's signature is the safest choice. Confirm with the school or the Idaho Department of Health and Welfare before using another clinician. Idaho's Medical Freedom Act (Idaho Code 73-503) limits medical mandates by schools and refers to the school immunization statute (39-4801 to 39-4804). Confirm how these apply to your child's school with the school or the Idaho Department of Health and Welfare.

Signed by: Licensed physician (MD or DO); confirm before using another clinician
Renewal: Per physician's recommendation.

Idaho DHW School and Daycare Information (no state form) (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian submits a signed written statement of objection to the school. The state exemption form may be used. Notarization not required. Idaho's Medical Freedom Act (Idaho Code 73-503) limits medical mandates by schools and refers to the school immunization statute (39-4801 to 39-4804). Confirm how these apply to your child's school with the school or the Idaho Department of Health and Welfare.

Signed by: Parent/guardian
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Idaho DHW School and Daycare Information (opens in a new tab)

Link verified on 2026-11-01

Personal belief Available

Parent/guardian submits a signed written statement of objection on religious or other grounds to the school. The state exemption form may be used. Idaho's Medical Freedom Act (Idaho Code 73-503) limits medical mandates by schools and refers to the school immunization statute (39-4801 to 39-4804). Confirm how these apply to your child's school with the school or the Idaho Department of Health and Welfare.

Signed by: Parent/guardian
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Idaho DHW School and Daycare Information (opens in a new tab)

Link verified on 2026-11-01

Medical Available

Submit form signed by a licensed physician (MD/DO), APRN, or PA to the school.

Signed by: MD, DO, APRN, or PA
Renewal: According to physician's determination.

77 Ill. Adm. Code 665.520 Medical Objection (no state form) (opens in a new tab)

Religious Available

Parent/guardian completes the Illinois Certificate of Religious Exemption, including a statement of the religious beliefs for each vaccine or exam, and submits it to the local school authority, which decides whether the objection is valid. The form must be signed by the parent/guardian and by the child's health care provider (physician, advanced practice nurse, or physician assistant), whose signature confirms only that information was provided. The form is required for students entering kindergarten, sixth, or ninth grade. No notarization required.

Signed by: Parent/guardian and health care provider sign; local school authority determines validity
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Illinois Certificate of Religious Exemption to Required Immunizations and/or Examinations (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit form completed by a licensed physician or an advanced practice provider to the school.

Signed by: Licensed physician (MD or DO) or advanced practice provider
Renewal: Maximum of one year. A new form must be completed annually if the exemption still applies.

Vaccine Medical Exemption, State Form 54648 (R3 / 8-26) (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian submits a signed written statement to the school saying the objection to immunization is based on religious grounds. There is no state form. No notarization required. This comes from a 2023 Indiana Department of Health FAQ. Ask the school whether it uses its own form.

Signed by: Parent/guardian
Renewal: Every school year. Give the school a new signed written objection each year.

IDOH School Immunization Requirements FAQs (2023-24) (no state form) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit form signed by a licensed physician (MD/DO), APRN, or PA to the school.

Signed by: MD, DO, APRN, or PA
Renewal: No set renewal period. It lasts until the expiration date the provider records, if any. An exemption for minimum vaccine spacing lasts no more than 60 days.

Medical Certificate of Immunization Exemption (July 2026) (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian signs the form. Submit to the admitting official of the school or licensed child care center. Iowa's statute still uses the word affidavit. Ask the school whether it needs anything beyond the signed state form.

Signed by: Parent/guardian
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Religious Certificate of Immunization Exemption (July 2024) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit form signed by a licensed physician (MD/DO) to the school.

Signed by: Licensed physician (MD or DO)
Renewal: According to physician's determination.

Kansas Certificate of Immunizations Form B: Medical Exemption (2026-27) (opens in a new tab)

Religious Available

Parent/guardian completes a written statement and submits to the school. Notarization not required.

Signed by: Parent/guardian
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

K.S.A. 72-6262 (no state form) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit the Commonwealth of Kentucky Certificate of Immunization Status with the medical exemption marked and signed by a licensed physician (MD/DO) to the school. Sources differ on whether other clinicians may sign, so a licensed physician's signature is the safest choice. Confirm with your local health department before using another clinician.

Signed by: Licensed physician (MD or DO); confirm before using another clinician
Renewal: Per provider's determination.

Commonwealth of Kentucky Certificate of Immunization Status (EPID-230), Medical Exemption box (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian completes and notarizes the sworn statement. Submit to school.

Signed by: Parent/guardian (with notarization)
Renewal: No yearly renewal. The EPID-230A does not expire. Provide an updated, notarized form if you object to a newly required vaccine or withdraw an objection to any vaccine. The school reviews immunization status at kindergarten, 7th and 11th grade entry and on transfer.

Parent or Guardian's Declination on Religious Grounds to Required Immunizations (EPID-230A) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit a statement signed by a licensed physician (MD/DO) to the school. Sources differ on whether other clinicians may sign, so a licensed physician's signature is the safest choice. Confirm with the Louisiana Department of Health or the school before using another clinician. Also ask whether a specific form is needed.

Signed by: Licensed physician (MD or DO); confirm before using another clinician
Renewal: As determined by physician.

Statement of Exemption from Immunizations (La. R.S. 17:170 E) (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian submits a written dissent to the school, either on the LDH Statement of Exemption form or as a written statement. The form has no notary section.

Signed by: Parent/guardian
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Statement of Exemption from Immunizations (La. R.S. 17:170 E) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Available

Parent/guardian submits a written dissent to the school, either on the LDH Statement of Exemption form or as a written statement. The form has no notary section.

Signed by: Parent/guardian
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Statement of Exemption from Immunizations (La. R.S. 17:170 E) (opens in a new tab)

Link verified on 2026-11-01

Medical Available

Submit a written statement from a licensed physician (MD/DO), nurse practitioner, or physician associate to the school. No specific form is required.

Signed by: MD, DO, NP, or physician associate
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Immunization Requirements for School Children FAQ (updated 7/13/2026) (no state form) (opens in a new tab)

Link verified on 2026-11-01

Religious Not available

Personal belief Not available

Medical Available

Submit Maryland Form 896 signed by a licensed physician (MD/DO) to the school. Sources differ on whether other clinicians may sign, so a licensed physician's signature is the safest choice. Confirm with your local health department before using another clinician.

Signed by: Licensed physician (MD or DO); confirm before using another clinician
Renewal: As indicated by physician.

Maryland Immunization Certificate (MDH Form 896), Medical Contraindication section (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian signs the religious objection section of Maryland Department of Health Form 896 and submits it to the school. The form is posted on the Maryland Department of Health website.

Signed by: Parent/guardian
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Maryland Immunization Certificate (MDH Form 896), Religious Objection section (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit a physician's written certification that immunization is medically contraindicated to the school.

Signed by: Licensed physician
Renewal: Annually at the start of the school year.

DPH Immunization Exemptions and VPD Exclusion in School Settings (no state form) (opens in a new tab)

Religious Available

Parent/guardian gives the school a written statement that immunization conflicts with their sincere religious beliefs. No notarization required.

Signed by: Parent/guardian
Renewal: Should be renewed every year at the start of the school year, per Massachusetts DPH.

M.G.L. c.76 s.15 (no state form) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit form signed by a licensed physician (MD/DO) to the school.

Signed by: Licensed physician (MD or DO)
Renewal: As determined by the physician; may be permanent.

MDHHS Immunization and Waiver Information for Schools and Childcares (opens in a new tab)

Religious Available

Parent/guardian must visit the local health department to receive vaccine education and have the waiver form certified. Then submit certified form to the school. Michigan's nonmedical waiver process may include an electronic waiver. Confirm with your local health department which waiver format your child's school accepts.

Signed by: Local health department (certifies after education session); parent/guardian signs
Renewal: The official guidance we read does not require yearly renewal for every student, but it is limited. A current, certified waiver is needed when a child enters childcare, preschool or Head Start, kindergarten, 7th grade, or a new school district. Confirm other grades with the school or local health department.

MDHHS Immunization and Waiver Information for Schools and Childcares (opens in a new tab)

Personal belief Available

Same process as religious exemption. Requires health department education session. A unified waiver form covers all non-medical exemptions. Michigan's nonmedical waiver process may include an electronic waiver. Confirm with your local health department which waiver format your child's school accepts.

Signed by: Local health department certifies; parent/guardian signs
Renewal: The official guidance we read does not require yearly renewal for every student, but it is limited. A current, certified waiver is needed when a child enters childcare, preschool or Head Start, kindergarten, 7th grade, or a new school district. Confirm other grades with the school or local health department.

MDHHS Immunization and Waiver Information for Schools and Childcares (opens in a new tab)

Medical Available

Submit a statement signed by a licensed physician (MD/DO) to the school. Sources differ on whether other clinicians may sign, so a licensed physician's signature is the safest choice. Confirm with your school or the Minnesota Department of Health before using another clinician.

Signed by: Licensed physician (MD or DO); confirm before using another clinician
Renewal: As determined by provider.

Are Your Kids Ready? Minnesota K-12 Immunization Law (exemptions on reverse side) (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian signs a non-medical exemption statement in front of a notary and submits it to the school. The statement may be the MDH immunization form, a form from the school, or the parent/guardian's own written objection to specific immunizations.

Signed by: Parent/guardian (with notarization)
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Get Your Non-Medical Exemption Form Notarized (MDH) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Available

Same process. Minnesota uses a unified 'conscientious exemption' that covers both religious and philosophical objections.

Signed by: Parent/guardian (with notarization)
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Are Your Kids Ready? Minnesota K-12 Immunization Law (exemptions on reverse side) (opens in a new tab)

Link verified on 2026-11-01

Medical Available

A licensed physician (MD/DO) completes a medical exemption request. Before filing, ask the Mississippi State Department of Health's Office of Immunizations for the current form and where it must be sent.

Signed by: Licensed physician (MD or DO)
Renewal: Confirm with the Office of Immunizations.

MSDH Vaccine Exemptions (opens in a new tab)

Religious Status unclear

Could not be confirmed. Ask the Mississippi State Department of Health's Office of Immunizations.

Personal belief Not available

Medical Available

Submit Missouri DHSS form Imm.P.12 signed by a licensed physician (MD/DO) to the school. Sources differ on whether other clinicians may sign, so a licensed physician's signature is the safest choice. Confirm with the school or the Missouri Department of Health and Senior Services before using another clinician.

Signed by: Licensed physician (MD or DO); confirm before using another clinician
Renewal: Based on physician's recommendation.

Medical Immunization Exemption (Imm.P.12) (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian completes the exemption form and submits it to the school. Notarization not required.

Signed by: Parent/guardian
Renewal: No yearly renewal for school. The signed Imm.P.11A stays on file with the school's immunization record.

Religious Immunization Exemption (Imm.P.11A) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

File a written medical exemption statement with the school, signed by a qualifying health care provider. Form HES-101A may be used, or a written and signed statement from the provider. A qualifying provider is licensed, certified, or authorized in any U.S. state or Canada to provide health care, is authorized to administer the immunization, and has previously provided care to the student or given a vaccine to which the student had an adverse reaction.

Signed by: Qualifying health care provider
Renewal: For the duration stated by the provider.

Medical Exemption Statement, Form HES-101A (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian completes form HES-113 and submits it to the school. Sources differ on notarization and yearly renewal, so have it notarized and renew it each year unless the school or the Montana Immunization Program, (406) 444-5580, confirms that is not required.

Signed by: Parent/guardian (with notarization)
Renewal: Each year, unless the school or the Montana Immunization Program confirms otherwise.

Religious Exemption Statement, Form HES-113 School (rev. 11/2024) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit form signed by a licensed physician (MD/DO), physician assistant, or nurse practitioner to the school.

Signed by: MD, DO, PA, or NP
Renewal: According to provider's statement.

Medical Exemptions from Vaccination Required for School Attendance in Nebraska (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian completes and notarizes the affidavit. Submit to school.

Signed by: Parent/guardian (with notarization)
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Affidavit: Refusal of Immunization of Student for Religious Reasons (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit form signed by a licensed physician (MD/DO) or advanced practice registered nurse (APRN) and by the parent/guardian to the school.

Signed by: Licensed physician (MD or DO) or APRN
Renewal: According to the provider's determination.

Preschool-12th Grade Medical Immunization Exemption Certificate (V2 08/23) (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian completes the form and submits to the school. No notarization required.

Signed by: Parent/guardian
Renewal: Annually, on the enrollment schedule set by the school district, charter school or private school.

Preschool-12th Grade Religious Immunization Exemption Certificate (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit a letter on letterhead from a licensed physician (MD/DO), APRN or physician associate certifying that immunization against a particular disease may be detrimental to the child's health to the school.

Signed by: MD, DO, APRN, or PA
Renewal: According to provider's determination.

RSA 141-C:20-c Exemptions (no state form) (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian completes and signs the New Hampshire Childcare/School Immunization Religious Exemption Form. Submit to school.

Signed by: Parent/guardian
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

New Hampshire Childcare/School Immunization Religious Exemption Form (opens in a new tab)

Personal belief Not available

Medical Available

Submit a written statement signed by a licensed physician (MD/DO) to the school. Ask the school or the New Jersey Department of Health which form to use. Sources differ on whether other clinicians may sign, so a licensed physician's signature is the safest choice. Confirm with them before using another clinician.

Signed by: Licensed physician (MD or DO); confirm before using another clinician
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

NJ Immunization Requirements (NJDOH) (no state form) (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian submits a signed written statement of religious objection to the school. Ask the school or the New Jersey Department of Health what it must say and whether it must be notarized.

Signed by: Parent/guardian
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

NJ Immunization Requirements (NJDOH) (no state form) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Parent/guardian completes the Certificate of Exemption, attaches a letter from a licensed physician, physician assistant, or certified nurse practitioner, signs before a notary, and files it with the New Mexico Department of Health for approval. The Department has 60 days to decide. Take the approved copy to the school.

Signed by: New Mexico Department of Health, on a certificate from an MD, DO, CNP, or PA
Renewal: Valid for up to twelve months. A new certificate and approval are needed after that.

Certificate of Exemption from School/Daycare Immunization Requirements (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian completes the Certificate of Exemption with a written religious affirmation or an attached affidavit, signs before a notary, and files it with the New Mexico Department of Health for approval. The Department has 60 days to decide. Take the approved copy to the school.

Signed by: New Mexico Department of Health
Renewal: Every year: an approved exemption lasts up to 12 months, then a new form must be filed and approved.

Certificate of Exemption from School/Daycare Immunization Requirements (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit form signed by a physician licensed to practice medicine in New York to the school. The form requires the specific medical contraindication to be stated.

Signed by: Physician licensed in New York
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Medical Exemption Statement for Children 0-18 Years (DOH-5077) (opens in a new tab)

Religious Not available

Personal belief Not available

Medical Available

Submit form signed by a licensed physician (MD/DO) to the school.

Signed by: Licensed physician (MD or DO)
Renewal: As indicated by the physician.

NC Medical Exemption Statement Form, DHHS 3987 (Rev. 08/20) (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian must submit a written statement of their religious objection. No notarization required. No state form is mandated — the parent's written statement serves as the exemption document.

Signed by: Parent/guardian (written statement)
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Vaccine Exemptions in NC (no state form) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit form signed by a licensed physician to the school.

Signed by: Licensed physician
Renewal: According to provider's recommendation.

Certificate of Immunization, SFN 16038 (Rev. 02-2024) (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian completes the form and submits to the school. Notarization not required.

Signed by: Parent/guardian
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Certificate of Immunization, SFN 16038 (Rev. 02-2024) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Available

Parent/guardian completes the form and submits to the school. Notarization not required.

Signed by: Parent/guardian
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Certificate of Immunization, SFN 16038 (Rev. 02-2024) (opens in a new tab)

Link verified on 2026-11-01

Medical Available

The child's physician certifies in writing that the immunization is medically contraindicated. Submit the certification to the school.

Signed by: Physician
Renewal: According to the healthcare provider's statement.

Ohio Revised Code 3313.671 (no state form) (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian submits a written statement to the school declining immunization for reasons of conscience, including religious convictions. The statute does not name a state form. Notarization not required. Ask the school whether it uses its own form.

Signed by: Parent/guardian
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Ohio Revised Code 3313.671 (no state form) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Available

Parent/guardian submits a written statement to the school declining immunization for reasons of conscience, including religious convictions. The statute does not name a state form. Notarization not required. Ask the school whether it uses its own form.

Signed by: Parent/guardian
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Ohio Revised Code 3313.671 (no state form) (opens in a new tab)

Link verified on 2026-11-01

Medical Available

Submit a certificate signed by a licensed physician to the Oklahoma State Department of Health (OSDH) Immunization Service through its online portal or by mail. PA, nurse or ARNP signatures are not accepted. OSDH approves or denies the request. After approval, the parent/guardian gives the approved certificate to the school.

Signed by: Licensed physician signs; Oklahoma State Department of Health Immunization Service approves
Renewal: Exemptions submitted before 7th grade expire at the end of the student's 6th grade year. A new exemption is required before enrolling in 7th grade.

Certificate of Medical Exemption (revised April 2026) (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian completes and signs the Certificate of Exemption and submits it to the Oklahoma State Department of Health (OSDH) Immunization Service through its online portal or by mail. OSDH approves or denies the request. After approval, the parent/guardian gives the approved certificate to the school.

Signed by: Oklahoma State Department of Health Immunization Service
Renewal: Exemptions submitted before 7th grade expire at the end of the student's 6th grade year. A new exemption is required before enrolling in 7th grade.

Certificate of Exemption (religious objection section) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Available

Parent/guardian completes and signs the Certificate of Exemption and submits it to the Oklahoma State Department of Health (OSDH) Immunization Service through its online portal or by mail. OSDH approves or denies the request. After approval, the parent/guardian gives the approved certificate to the school.

Signed by: Oklahoma State Department of Health Immunization Service
Renewal: Exemptions submitted before 7th grade expire at the end of the student's 6th grade year. A new exemption is required before enrolling in 7th grade.

Certificate of Exemption (personal objection section) (opens in a new tab)

Link verified on 2026-11-01

Medical Available

A physician (MD, DO, or naturopathic physician, as defined on the form) or a local health department representative completes the Oregon Medical Exemption Form. The parent/guardian brings it to the school or child care, which submits it to the local health department for review. The local health department approves or denies the request.

Signed by: Physician or local health department representative completes; local health department approves
Renewal: Permanent, or temporary until the date stated on the form. The local health department sets any review date.

Oregon Medical Exemption Form (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian must either: (1) get a Vaccine Education Certificate signed by a health care practitioner after discussing vaccines, OR (2) complete the OHA online Vaccine Education Module and print the certificate. The education must have taken place within the past 12 months. Then fill out the nonmedical exemption section of the Certificate of Immunization Status form and submit both documents to the school.

Signed by: Parent/guardian with education requirement
Renewal: No annual renewal: once on file, the nonmedical exemption does not expire and can be transferred to a new school. New documentation may be needed when a child moves from child care to kindergarten.

OHA Nonmedical Exemption page (opens in a new tab)

Link verified on 2026-11-01

Personal belief Available

Same process as religious exemption. Oregon uses one nonmedical exemption process: the nonmedical exemption section of the Certificate of Immunization Status form plus a Vaccine Education Certificate.

Signed by: Parent/guardian with education requirement
Renewal: No annual renewal: once on file, the nonmedical exemption does not expire and can be transferred to a new school. New documentation may be needed when a child moves from child care to kindergarten.

OHA Nonmedical Exemption page (opens in a new tab)

Link verified on 2026-11-01

Medical Available

Submit a written statement from a physician or the physician's designee to the school. The state Certificate of Immunization form has a physician signature line for this.

Signed by: Physician or physician's designee
Renewal: Based on provider's determination.

Certificate of Immunization (SIR-2, H502.320), Statement of Exemption on page 2 (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian completes form and submits to school. Notarization not required.

Signed by: Parent/guardian
Renewal: No yearly renewal is required.

Certificate of Immunization (SIR-2, H502.320), Statement of Exemption on page 2 (opens in a new tab)

Link verified on 2026-11-01

Personal belief Available

Parent/guardian completes form and submits to school. Notarization not required.

Signed by: Parent/guardian
Renewal: No yearly renewal is required.

Certificate of Immunization (SIR-2, H502.320), Statement of Exemption on page 2 (opens in a new tab)

Link verified on 2026-11-01

Medical Available

Submit form signed by a licensed physician (MD/DO), nurse practitioner, or physician assistant to the school.

Signed by: MD, DO, NP, or PA
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Medical Immunization Exemption Certificate (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian completes and signs the state Religious Immunization Exemption Certificate, provided by the school. Submit to school.

Signed by: Parent/guardian
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Religious Immunization Exemption Certificate (May 1, 2019) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit the South Carolina Certificate of Immunization, with the medical exemption completed by an individual licensed to practice medicine, surgery, or osteopathy or his/her representative, to the school.

Signed by: Individual licensed to practice medicine, surgery, or osteopathy, or his/her representative
Renewal: According to physician's determination.

SC DPH Exemptions from School Vaccine Requirements (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian must obtain the South Carolina Certificate of Religious Exemption from the health department, in person or online, sign it, have it notarized, and submit it to the school.

Signed by: Parent/guardian, with notarization; form obtained from the health department
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

SC DPH Childhood Vaccine Exemption (online religious exemption form) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit certification from a licensed physician on the South Dakota Department of Health Certificate of Immunization form to the school.

Signed by: Licensed physician
Renewal: According to provider's recommendation.

SD Administrative Rules ch. 44:81:06 (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian signs the South Dakota Department of Health Certificate of Immunization form, or provides a signed statement that the child is an adherent to a religious doctrine whose teachings are opposed to immunization. Submit to school.

Signed by: Parent/guardian
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

SD Administrative Rules ch. 44:81:06 (no state form) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Physician (MD/DO) or Public Health Nurse indicates the specific vaccines medically exempted on the Tennessee Certificate of Immunization. Submit to the school. The medical reason does not need to be provided. This comes from Tennessee Department of Health guidance last updated in January 2019. Confirm with your child's school.

Signed by: Physician (MD or DO) or Public Health Nurse
Renewal: As indicated by provider.

TDH Summary of Immunization Rules - Certificate Instructions (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian files a signed written statement with the school that vaccination conflicts with their religious tenets or practices. Schools or districts may have local procedures, including notarization. Confirm with your child's school.

Signed by: Parent/guardian
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

TDH Vaccine-Preventable Diseases and Immunization Program (Exemptions) (no state form) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit written statement from a licensed physician (MD/DO) stating the medical contraindication. Submit to school.

Signed by: Licensed physician (MD or DO)
Renewal: Every year, counted from the date the physician signed, unless the physician specifies a lifelong condition.

Texas DSHS Immunization Exemptions (no state form) (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian completes the official DSHS affidavit form (Stock No. F11-11755), which can be downloaded from DSHS or requested from DSHS. The form covers reasons of conscience including religious beliefs. The affidavit must be notarized and must be submitted to the school within 90 days of being notarized.

Signed by: Parent/guardian or individual (age 18+)
Renewal: Valid for two years from the date of notarization. Must be submitted to the school within 90 days of being notarized.

Affidavit: Exemption for Reasons of Conscience (Stock F11-11755) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Available

Texas uses a unified notarized affidavit for all reasons of conscience, including religious beliefs and philosophical objections. The same form is used for both.

Signed by: Parent/guardian or individual (age 18+)
Renewal: Valid for two years from the date of notarization. Must be submitted to the school within 90 days of being notarized.

Affidavit: Exemption for Reasons of Conscience (Stock F11-11755) (opens in a new tab)

Link verified on 2026-11-01

Medical Available

Legally responsible individual completes the online education module or an in-person consultation at a local health department, then gives the school a completed vaccination exemption form and a written notice signed by a licensed health care provider.

Signed by: Licensed health care provider
Renewal: The form remains valid for as long as the student remains enrolled in the public education system.

Utah Immunization Education Module and exemption form (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Legally responsible individual completes the online education module or an in-person consultation at a local health department, then gives the school a copy of the completed vaccination exemption form.

Signed by: Parent/guardian (with online education module or in-person consultation)
Renewal: The form remains valid for as long as the student remains enrolled in the public education system.

Utah Immunization Education Module and exemption form (opens in a new tab)

Link verified on 2026-11-01

Personal belief Available

Legally responsible individual completes the online education module or an in-person consultation at a local health department, then gives the school a copy of the completed vaccination exemption form.

Signed by: Parent/guardian (with online education module or in-person consultation)
Renewal: The form remains valid for as long as the student remains enrolled in the public education system.

Utah Immunization Education Module and exemption form (opens in a new tab)

Link verified on 2026-11-01

Medical Available

Submit form signed by a licensed physician (MD/DO), nurse practitioner, or physician assistant to the school.

Signed by: MD, DO, NP, or PA
Renewal: No set yearly renewal: valid for the dates the health care practitioner puts on the form, ending when the condition no longer applies.

Medical Immunization Exemption, Child Care and Schools (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian completes the form. Beginning in 2016, Vermont requires that parents submit a signed statement annually. Submit to school.

Signed by: Parent/guardian
Renewal: Every year, on the current school year's form.

Religious Immunization Exemption, Academic Year 2026-2027 (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit written medical exemption certification to the school. The Virginia Department of Health's School Entrance Health Form (MCH213G) includes a medical exemption section. Virginia sources list different signers, so a licensed physician's signature is the safest choice. Confirm with your local health department before using another clinician.

Signed by: Licensed physician (MD or DO); confirm before using another clinician
Renewal: According to provider's certification.

School Entrance Health Form MCH213G, Part II Section II (Medical Exemption) (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian completes and notarizes Form CRE-1. Submit notarized form to school.

Signed by: Parent/guardian (with notarization)
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Certificate of Religious Exemption, Form CRE-1 (Rev. 00/92) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit form signed by a licensed physician (MD/DO), nurse practitioner, physician assistant, or naturopathic physician (ND) to the school.

Signed by: MD, DO, NP, PA, or ND
Renewal: According to provider's determination.

Certificate of Exemption (DOH 348-106) (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian must complete the Certificate of Exemption and have it signed by a healthcare provider. The provider's signature verifies that the parent received vaccine education — it does NOT mean the provider endorses the exemption. Submit completed COE to school. A separate religious membership exemption, for families who belong to a church or religion whose teachings do not allow health care practitioners to give medical treatment to the child, does not need a health care practitioner's signature.

Signed by: Parent/guardian with healthcare provider signature for education
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Certificate of Exemption (DOH 348-106) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Available

Same process as religious exemption, except that measles, mumps, and rubella (MMR) may not be exempted for personal/philosophical reasons.

Signed by: Parent/guardian with healthcare provider signature for education
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Certificate of Exemption (DOH 348-106) (opens in a new tab)

Link verified on 2026-11-01

Medical Available

A licensed physician who has treated or examined the child submits the request to the State Immunization Officer, stating which vaccines are involved, the medical contraindication or precaution, and whether the exemption is permanent or temporary. The Immunization Officer approves or denies the request. The decision may be appealed to the State Health Officer. Religious exemptions in West Virginia are the subject of pending litigation. Confirm the current status with your county board of education or the West Virginia Department of Health.

Signed by: State Immunization Officer
Renewal: Permanent or temporary as determined on the request. Temporary medical exemption requests may not exceed 24 months.

Request for Medical Exemption From Compulsory Immunization (opens in a new tab)

Link verified on 2026-11-01

Religious Status unclear

In litigation. The State Board of Education has directed county boards not to accept them for now. Confirm with your county board of education.

Personal belief Not available

Medical Available

Submit the state waiver form signed by a licensed physician (MD/DO) to the school. Sources differ on whether other clinicians may sign, so a licensed physician's signature is the safest choice. Confirm with the school or local health department before using another clinician.

Signed by: Licensed physician (MD or DO); confirm before using another clinician
Renewal: According to provider's recommendation.

Student Immunization Record, F-04020L (05/2024), Waivers section (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian completes the form and submits to school. Notarization not required.

Signed by: Parent/guardian
Renewal: No yearly renewal stated. The waiver covers vaccines required when the student first enrolls in a Wisconsin school, and a new vaccine or dose required later needs a separate waiver. Confirm with the school.

Student Immunization Record, F-04020L (05/2024), Waivers section (opens in a new tab)

Link verified on 2026-11-01

Personal belief Available

Parent/guardian completes the form and submits to school. Notarization not required.

Signed by: Parent/guardian
Renewal: No yearly renewal stated. The waiver covers vaccines required when the student first enrolls in a Wisconsin school, and a new vaccine or dose required later needs a separate waiver. Confirm with the school.

Student Immunization Record, F-04020L (05/2024), Waivers section (opens in a new tab)

Link verified on 2026-11-01

Medical Available

Submit the Medical Waiver Request, completed by a physician licensed in the U.S., or a signed statement from a licensed physician, to the State Health Officer or a County Health Officer. If the waiver is approved, give a copy of the approved waiver to the school.

Signed by: State Health Officer or County Health Officer, on evidence from a licensed physician
Renewal: According to physician's direction.

Medical Waiver Request (opens in a new tab)

Link verified on 2026-11-01

Religious Available

Parent/guardian submits the Religious Waiver Request, or a signed statement of religious objection to a specific immunization, to the State Health Officer or a County Health Officer. If the waiver is approved, give a copy of the approved waiver to the school. Notarization not required.

Signed by: State Health Officer or County Health Officer
Renewal: Not stated in the official sources we read. Check each school year and confirm with the school or health department.

Religious Waiver Request (IMM-003) (opens in a new tab)

Link verified on 2026-11-01

Personal belief Not available

Medical Available

Submit form completed by a qualified health professional (physician, nurse practitioner, or registered nurse) to the school or public health unit.

Signed by: Physician, NP, or RN
Renewal: According to healthcare provider's direction.

Alberta Immunization Program — Official Health Department (opens in a new tab)

Religious Available

Parent/guardian completes the non-medical exemption form. Must be notarized or signed in the presence of a commissioner for oaths. Submit to school or public health.

Signed by: Parent/guardian (with notarization/commissioner)
Renewal: One-time submission; typically does not require annual renewal.

Alberta Immunization Program — Official Health Department (opens in a new tab)

Personal belief Not available

Medical Available

Submit form completed by a physician or nurse practitioner to the school or public health unit.

Signed by: Physician (MD) or Nurse Practitioner
Renewal: According to the healthcare provider's assessment.

British Columbia Immunization Program — Official Health Department (opens in a new tab)

Religious Available

Parent/guardian completes the form. BC does not require notarization. Submit to school or public health unit.

Signed by: Parent/guardian
Renewal: Typically one-time; may require re-submission if transferring schools.

British Columbia Immunization Program — Official Health Department (opens in a new tab)

Personal belief Not available

Medical Available

Submit form completed by a physician or nurse practitioner to the school. The form must state the specific medical contraindication.

Signed by: Physician or Nurse Practitioner
Renewal: As designated by the healthcare provider.

Manitoba Immunization Program — Official Health Department (opens in a new tab)

Religious Available

Parent/guardian completes the conscientious objection section. Must be signed by a commissioner for oaths or notary public.

Signed by: Parent/guardian (with commissioner for oaths/notary)
Renewal: One-time submission.

Manitoba Immunization Program — Official Health Department (opens in a new tab)

Personal belief Not available

Medical Available

Submit form completed by a physician or nurse practitioner. Include with the school immunization record.

Signed by: Physician or Nurse Practitioner
Renewal: According to the provider's statement.

New Brunswick Immunization Program — Official Health Department (opens in a new tab)

Religious Available

Parent/guardian completes the non-medical exemption form and submits to the school. No notarization required by the province.

Signed by: Parent/guardian
Renewal: One-time submission is generally sufficient.

New Brunswick Immunization Program — Official Health Department (opens in a new tab)

Personal belief Not available

Medical Available

Submit form completed by a physician or nurse practitioner to the school or public health nurse.

Signed by: Physician or Nurse Practitioner
Renewal: As indicated by the healthcare provider.

Newfoundland and Labrador Immunization Program — Official Health Department (opens in a new tab)

Religious Available

Parent/guardian completes the form. Not required to be notarized. Submit to school or public health.

Signed by: Parent/guardian
Renewal: One-time submission.

Newfoundland and Labrador Immunization Program — Official Health Department (opens in a new tab)

Personal belief Not available

Medical Available

Submit form completed by a physician or nurse practitioner to the school or public health unit.

Signed by: Physician or Nurse Practitioner
Renewal: According to provider's direction.

Northwest Territories Immunization Program — Official Health Department (opens in a new tab)

Religious Available

Parent/guardian must submit a signed written statement to the school or local public health unit explaining the religious or conscientious objection. Contact the local public health unit for specific requirements.

Signed by: Parent/guardian
Renewal: Annually, at beginning of school year.

Northwest Territories Immunization Program — Official Health Department (opens in a new tab)

Personal belief Not available

Medical Available

Submit form completed by a physician or nurse practitioner to the school.

Signed by: Physician or Nurse Practitioner
Renewal: According to the healthcare provider's determination.

Nova Scotia Immunization Program — Official Health Department (opens in a new tab)

Religious Available

Parent/guardian completes the form. Not required to be notarized. Submit to school.

Signed by: Parent/guardian
Renewal: One-time submission.

Nova Scotia Immunization Program — Official Health Department (opens in a new tab)

Personal belief Not available

Medical Available

Submit a letter from a physician or nurse practitioner stating the medical contraindication to the school or community health centre.

Signed by: Physician or Nurse Practitioner
Renewal: According to the healthcare provider's direction.

Nunavut Immunization Program — Official Health Department (opens in a new tab)

Religious Available

Parent/guardian should contact the local community health centre or school for the current exemption procedure. A signed, dated written statement is typically required. Individual communities may have specific forms.

Signed by: Parent/guardian
Renewal: Annually.

Nunavut Immunization Program — Official Health Department (opens in a new tab)

Personal belief Not available

Medical Available

Submit Form 014-4897-64 signed by a physician or nurse practitioner to the school. The form must specify which vaccines are medically contraindicated and the reason.

Signed by: Physician (MD) or Nurse Practitioner (NP)
Renewal: Must be updated if the medical condition changes; does not require automatic annual renewal.

Ontario Immunization Program — Official Health Department (opens in a new tab)

Religious Available

Parent/guardian must complete the Statement of Conscience or Religious Belief form AND complete a vaccine education session. The education session must be completed before the exemption form is processed. After completing education, submit the notarized (or commissioner-signed) form to the school.

Signed by: Parent/guardian (with notarization/commissioner, plus mandatory education session)
Renewal: One-time for the student's time at that school level. Education session must be completed once.

Ontario Immunization Program — Official Health Department (opens in a new tab)

Personal belief Not available

Medical Available

Submit a letter from a physician or nurse practitioner stating the medical contraindication. Contact Health PEI or the school for the most current procedures.

Signed by: Physician or Nurse Practitioner
Renewal: According to healthcare provider's direction.

Prince Edward Island Immunization Program — Official Health Department (opens in a new tab)

Religious Available

Parent/guardian must submit a signed, dated written statement explaining the religious or conscientious objection to the school. Contact the school or Public Health Nursing office for current forms and procedures.

Signed by: Parent/guardian
Renewal: One-time submission typically.

Prince Edward Island Immunization Program — Official Health Department (opens in a new tab)

Personal belief Not available

Medical Available

Submit a medical certificate from a physician or specialized nurse practitioner stating the specific contraindication. Include with the child's vaccination record at the school or CLSC.

Signed by: Physician (MD) or Specialized Nurse Practitioner (IPS)
Renewal: According to the healthcare provider's certification.

Quebec Immunization Program — Official Health Department (opens in a new tab)

Religious Available

Quebec does not have a standardized provincial exemption form for non-medical exemptions. Parent/guardian should provide a signed, dated written statement explaining the objection. The school/service de garde determines the sufficiency. Contact the local CLSC or school administration for current procedures.

Signed by: Parent/guardian (statement reviewed by school administration)
Renewal: Annually at school entry.

Quebec Immunization Program — Official Health Department (opens in a new tab)

Personal belief Not available

Medical Available

Submit form completed by a physician or nurse practitioner. Submit to the school or public health office.

Signed by: Physician or Nurse Practitioner
Renewal: According to the healthcare provider's assessment.

Saskatchewan Immunization Program — Official Health Department (opens in a new tab)

Religious Available

Parent/guardian completes the form. Saskatchewan requires the form to be notarized or signed before a commissioner for oaths. Submit to school or public health.

Signed by: Parent/guardian (with notarization/commissioner)
Renewal: One-time submission.

Saskatchewan Immunization Program — Official Health Department (opens in a new tab)

Personal belief Not available

Medical Available

Submit a letter from a physician or nurse practitioner stating the medical contraindication to the school or Yukon Communicable Disease Control.

Signed by: Physician or Nurse Practitioner
Renewal: According to the healthcare provider's direction.

Yukon Immunization Program — Official Health Department (opens in a new tab)

Religious Available

Parent/guardian must submit a signed, dated written statement to Yukon Communicable Disease Control (YCDC) or the school, stating the religious or conscientious objection. Contact YCDC at 867-667-8323 for current forms and procedures.

Signed by: Parent/guardian
Renewal: Annually.

Yukon Immunization Program — Official Health Department (opens in a new tab)

Personal belief Not available