Vaccine Exemption Forms

                                 LISTED IN ALPHABETICAL ORDER

ALABAMA

ALASKA 

Exemption Forms Allowed: Medical, Religious

Alaska Medical Exemption Form

Alaska Religious Exemption Form

Alaska Immunization Religious Exemption Form

Alaska Immunization Medical Vaccine Exemption Form

Alaska Immunization Religious Vaccine Exemption Form

Alaska Medical & Religious Exemption Forms {pgs.13&14}

Alaska Medical & Religious Exemption Forms {pgs.36&37}

State of Alaska Department of Correction Hepatitis B Exemption Form

Hepatitis B Vaccine Immunization Exemption Form

University of Alaska Anchorage Employee Hepatitis B Waiver

ARIZONA

Exemption Forms Allowed: Medical, Philosophical, Religious

Arizona Philosophical & Medical Exemption Form

Arizona Religious & Medical Exemption Form

Arizona Religious Exemption Higher Education

ARKANSAS

Exemption Forms Allowed: Medical, Philosophical, Religious

Arkansas Has No Online Exemption Forms Available

Request Exemption Forms email:

mailto:immunization.section@arkansas.gov

Arkansas Medical Form Information

Arkansas Philosophical & Religious Information

Arkansas Immunization Exemption Process{pgs.7&8}

AUSTRALIA

Exemption Forms Allowed: Medical

Australian Medical Contraindication Exemption Form

Australian Child Immunization Exemption Form

CANADA

Exemption Forms Allowed: Medical, Philosophical, Religious

Ontario Ministry of Health Conscience & Religious Exemption Form

CALIFORNIA

Exemption Forms Allowed: Medical, Philosophical

California Personal Beliefs Affidavit

California Exemption Affidavit Form

COLORADO

Exemption Forms Allowed: Medical, Philosophical, Religious

Colorado K-12 Public School Vaccine Exemption Forms

Colorado Certificate of Immunization College Exemption Form

Colorado College Certificate of Immunization Exemption Form

Colorado Hepatitis B Vaccine Exemption Waiver

Colorado Refusal of Vaccine Form

CONNECTICUT

Exemption Forms Allowed: Medical, Religious

Connecticut Medical Exemption Form

Connecticut Religious Exemption Form

Connecticut Vaccine Exemption Forms Multiple Languages

University of Connecticut Immunization Exemption Form

University of Connecticut School of Law Exemption Form

Connecticut College Religious Exemption Form

Central Connecticut University Exemptions & Waivers

DELAWARE 

Exemption Forms Allowed: Medical, Religious

Delaware Affidavit of Religious Belief Exemption Form

Delaware Vaccine Affidavit Outline & Process

University of Delaware Medical & Religious Exemptions

University of Delaware Hepatitis B Waiver

Vaccine Refusal Form

DISTRICT OF COLUMBIA

Exemption Forms Allowed: Medical, Religious

District of Columbia Has No Online Exemption Forms

FLORIDA

Exemption Forms Allowed: Medical, Religious

Florida’s Online Vaccine Enrollment Program to Obtain Exemptions

Sample Florida Medical Exemption Form DH-680

Sample Florida Religious Exemption Form DH-681

University of Florida Medical Vaccine Exemption Form

GEORGIA

Exemption Forms Allowed: Medical, Religious

Georgia Department of Human Resources Vaccine Opt Out Registry Form

Georgia State University Immunization Exemption Forms

Georgia State University Doctoral Program Exemption Form

Gainesville College Religious Exemption Form

Georgia Perimeter College Religious Exemption Form

Georgia’s Public Liberal Arts University Immunization Exemption Forms

Floyd College Georgia Certificate of Immunization Exemptions

Georgia University System Religious & Medical Exemptions

HAWAII

Exemption Forms Allowed: Medical, Religious

Hawaii Religious Vaccination Exemption Form

Hawaii Religious Vaccine Exemption Form

State of Hawaii Vaccine Refusal Exemption Form

State of Hawaii TB Waiver Form

IDAHO

Exemption Forms Allowed: Medical, Philosophical, Religious

Idaho Philosophical, Medical & Religious Exemption Forms

Idaho Philosophical, Medical & Religious Exemption Forms {Spanish}

Idaho Medical & Philosophical Vaccine Exemption Forms

Idaho Religious Vaccine Exemption Form

Idaho Online Opt Out Immunization Form

ILLINOIS

Exemption Forms Allowed: Medical, Religious

Illinois Religious Vaccine Exemption Form

Illinois Religious Exemption Form

Illinois University Edwardsville Religious Exemption Form

Illinois University Edwardsville Medical Exemption Form

Illinois Millikin University Religious Exemption Form

Illinois Aurora University Medical Immunization Exemption Form

INDIANA

Exemption Forms Allowed: Medical, Religious

Indiana Medical Vaccine Exemption Form 54648

Indiana Religious Exemption Form

Indiana Religious Vaccine Exemption Form

Valparaiso University Medical & Religious Exemptions

IOWA

Exemption Forms Allowed: Medical, Religious

Iowa IDPH Medical Vaccine Exemption Form

Iowa IDPH Religious Vaccine Exemption Form

Iowa Religious & Medical Vaccine Exemption Forms

Iowa Vaccine Exemption Forms 888-398-9696

KANSAS

Exemption Forms Allowed: Medical, Religious

Kansas Medical Vaccine Exemption Form

University of Kansas Immunization Waiver

KENTUCKY

Exemption Forms Allowed: Medical, Religious

Kentucky Certificate of Medical Exemption

Kentucky Certificate of Religious Exemption

Kentucky Vaccination Religious Affidavit

Kentucky Request for Religious Exemption Form

LOUISIANA

Exemption Forms Allowed: Medical, Philosophical, Religious

No Online School Enrollment Vaccine Exemption Forms Available

Only Available for State Colleges and Universities.

Louisiana Southern University Vaccine Exemption Forms

Louisiana Southeastern University Vaccine Exemption Request Form

Louisiana State University Immunization Exemption Request Form

Louisiana State University Eunice Immunization Exemption Request Form

 

MAINE

Exemption Forms Allowed: Medical, Philosophical, Religious

No Official Online PDF Forms Below is a Printable Version:

Maine Immunization Program:

http://www.maine.gov/dhhs/boh/ddc/immunization/index.shtml

Maine  State Health Department:

http://www.maine.gov/dhhs/

MARYLAND

Exemption Forms Allowed: Medical, Religious

Maryland Department of Health& Mental Hygiene Vaccine Exemption Forms:

No online form available Removed as of 3-16-2011

Maryland State Legislature:

http://mlis.state.md.us

Contact Maryland State Governors Office:

http://www.dhmh.maryland.gov/SitePages/Home.aspx

Maryland State Health Department:

http://www.dhmh.state.md.us/

MASSACHUSETTS

Exemption Forms Allowed: Medical, Religious

Immunization Exemptions & Guidelines:

http://www.mass.gov/eohhs/docs/dph/cdc/meningitis/regs-memo.pdf

Massachusetts State Health & Human Services:

http://www.mass.gov/?pageID=mg2homepage&L=1&L0=Home&sid=massgov2

MICHIGAN

Exemption Forms Allowed: Medical, Philosophical, Religious

Immunization Waiver Form:

http://www.momvaccines.org/SS_Imm_Wavier_March_2011%5B1%5D.pdf

Michigan State Health Services:

http://www.michigan.gov/mdch

MINNESOTA

Exemption Forms Allowed: Medical, Philosophical, Religious

Minnesota’s School Immunization Law Exemption Provision:

http://www.health.state.mn.us/divs/idepc/immunize/laws/exemption.html

Minnesota State Health Department:

http://www.health.state.mn.us/

MISSISSIPPI

Exemption Forms Allowed: Medical

No Official Online form

Your written form must be signed by the District Health Officer:

Mississippi immunization Schedule & Exemption Procedure:

http://www.msdh.state.ms.us/msdhsite/_static/resources/2029.pdf

Mississippi State Legislature:

http://billstatus.ls.state.ms.us/

Mississippi State Health Department:

http://www.msdh.state.ms.us/

MISSOURI

Exemption Forms Allowed: Medical, Religious

Missouri School Vaccine Exemption Form:

https://www.sos.mo.gov/adrules/csr/previous/19csr/19csr699/19c20-28a.pdf

Missouri State Legislature:

www.moga.mo.gov

Missouri State Health Department:

http://health.mo.gov/index.php

MONTANA

Exemption Forms Allowed: Medical, Religious

Montana Religious Exemption Form:

http://www.gallatingatewayschool.com/media/pdf/forms/ReligiousExemptForm.pdf

Montana State Legislature:

http://leg.mt.gov/css/default.asp

Montana State Health Department:

http://www.dphhs.mt.gov/

NEBRASKA

Exemption Forms Allowed: Medical, Religious

Refusal of Immunization of Student for Religious Reasons:

http://dhhs.ne.gov/publichealth/Documents/MedicalExemption.pdf

Refusal of Immunization on Medical ground:

Nebraska State Legislature:

http://nebraskalegislature.gov/

Nebraska Health and Human Services Division:

www.hhs.state.ne.us

NEVADA

Exemption Forms Allowed: Medical, Religious

No Official Online Forms Please read the nrs392Sec437 listed below to learn your rights:

http://www.leg.state.nv.us/NRS/NRS-392.html#NRS392Sec437

Nevada Health and Human Services Division:

http://health.nv.gov/

Nevada State Legislature:

http://www.leg.state.nv.us/

NEW HAMPSHIRE

Exemption Forms Allowed: Medical, Religious

No official online forms please see the State Constitution below to know your rights:

http://hebinec.cwahi.net/vaccine-exemption-forms-for-nh.php

New Hampshire State Legislature:
http://gencourt.state.nh.us/

New Hampshire State Health Department:

http://www.dhhs.nh.gov/

NEW JERSEY

Exemption Forms Allowed: Medical, Religious

No official online forms:

Make sure to get written forms notarized.

Religious Exemption Procedure:

http://www.vaclib.org/chapter/cherubs.htm

New Jersey State Legislature:

http://www.njleg.state.nj.us/

New Jersey State Health Department:

http://www.state.nj.us/health/

NEW MEXICO

Exemption Forms Allowed: Medical, Philosophical, Religious

New Mexico Exemption Forms:

New Mexico State Health Department:

http://www.health.state.nm.us/

NEW YORK

Exemption Forms Allowed: Medical, Religious

No Online Forms Please follow these guidelines:

http://www.vaclib.org/exempt/newyork.htm

New York State Assembly:

http://assembly.state.ny.us/

New York State Health Department:

http://www.health.state.ny.us/

New York Health Department Immunization Schedule:

http://www.health.state.ny.us/prevention/immunization/

NORTH CAROLINA

Exemption Forms Allowed: Medical, Religious

Religious Exemption Forms:

http://www.vaclib.org/exempt/northcarolina.htm#letters

North Carolina State Health Department:

http://ncdhhs.gov/dph/wch/

NORTH DAKOTA

Exemption Forms Allowed: Medical, Philosophical, Religious

North Dakota Certificate of Immunization & Exemptions:

http://www.ndhealth.gov/Immunize/Documents/Providers/Forms/CertificateofImmunization.pdf

North Dakota State Department of Health:

http://www.ndhealth.gov/

North Dakota Legislative Branch:

http://www.legis.nd.gov/

OHIO

Exemption Forms Allowed: Medical, Philosophical, Religious

No Official Online PDF Forms:

Ohio State Health Department:

http://www.odh.ohio.gov/odhPrograms/dis/immunization/immindex1.aspx

Ohio General Assembly:

http://www.legislature.state.oh.us/

 OKLAHOMA

Exemption Forms Allowed: Medical, Philosophical, Religious

Oklahoma Vaccine Exemption Forms make sure to get Notarized:

http://www.unhinderedliving.com/exemptionform.html

Oklahoma State Health Department:

http://www.ok.gov/health/

OREGON

Exemption Forms Allowed: Medical, Religious

No Online Forms Write Oregon Health Department follow these guidelines:

http://www.vaclib.org/exempt/oregon.htm

Oregon State Legislature:

http://www.leg.state.or.us/

Oregon State Health Department:

http://public.health.oregon.gov/Pages/Home.aspx

PENNSYLVANIA

Exemption Forms Allowed: Medical, Religious

Pennsylvania Medical & Religious Exemption Form:

http://www.unhinderedliving.com/Vaccine.jpg

Pennsylvania State Health Department:

http://www.portal.health.state.pa.us/portal/server.pt/community/department_of_health_home/17457

Pennsylvania General Assembly:

http://www.legis.state.pa.us/

RHODE ISLAND

Exemption Forms Allowed: Medical, Religious

Rhode Island School Immunization Rules & Exemptions:

http://www2.sec.state.ri.us/dar/regdocs/released/pdf/DOH/DOH_3523.pdf

http://www2.sec.state.ri.us/dar/regdocs/released/pdf/DOH/DOH_3582.pdf

Rhode Island Health Department:

http://www.health.state.ri.us/

Rhode Island General Assembly:

http://www.rilin.state.ri.us/

SOUTH CAROLINA

Exemption Forms Allowed: Medical, Religious

No Official Online Form contact your Regional Health Office:

http://www.scdhec.gov/health/countymap.htm

South Carolina Health Department:

http://www.scdhec.gov/index.htm

South Carolina General Assembly:

http://www.scstatehouse.gov/

SOUTH DAKOTA

Exemption Forms Allowed: Medical, Religious

No Online Vaccine Forms Contact State Health Department:

http://doh.sd.gov/Immunize/School.aspx

South Dakota State Health Department:

http://www.sd.gov/

South Dakota Legislature:

http://legis.state.sd.us/index.aspx

TENNESSEE

Exemption Forms Allowed: Medical, Religious

No Official Online Forms Follow these Guidelines:

http://www.vaclib.org/exempt/tennessee.htm

Tennessee State Health Department Immunizations & Exemptions:

http://health.state.tn.us/Ceds/immunization.htm

Tennessee General Assembly:

http://www.legislature.state.tn.us/

Tennessee State Government:

http://www.state.tn.us/

TEXAS

Exemption Forms Allowed: Medical, Philosophical, Religious

No Online Texas Vaccine Exemption Forms follow these guidelines

Make Sure to get written forms Notarized:

http://www.vaclib.org/exempt/texas.htm

Texas Vaccine Exemption & Regulations:

http://www.dshs.state.tx.us/immunize/school/default.shtm#infoforschoolchildcare

Texas Health & Human Services:

http://www.hhs.state.tx.us/

Texas State Legislature:

http://www.capitol.state.tx.us/

UTAH

Exemption Forms Allowed: Medical, Philosophical, Religious

Utah Immunization Exclusion & Exemptions:

http://health.utah.gov/epi/cdepi/Imm_Exclusion_FS.pdf

Utah Immunization Guidelines Exemption Forms:

http://www.immunize-utah.org/provider/school/2011-2012%20Immunization%20Guidebook.pdf

Utah State Health Department:

http://health.utah.gov/

Utah State Legislature:

http://le.utah.gov/

VERMONT

Exemption Forms Allowed: Medical, Philosophical, Religious

Vermont School Vaccine Exemption Forms:

http://healthvermont.gov/hc/imm/documents/School_Immunization_Exemption_Form.pdf

Vermont State Legislature:

http://www.politicsol.com/govsites/state-legislatures/vt.html

Vermont State Health Department:

http://healthvermont.gov/

VIRGINIA

Exemption Forms Allowed: Medical, Religious

Virginia Religious Exemption Form:

http://www.vdh.virginia.gov/epidemiology/immunization/documents/cre_1.pdf

West Virginia Vaccination Exemptions:

http://www.wvve.info/index.html

Virginia State Health Department:

http://www.vdh.state.va.us/

Virginia General Assembly:

http://legis.state.va.us/

WASHINGTON

Exemption Forms Allowed: Medical, Philosophical, Religious

Washington Exemption Forms:

http://www.vaclib.org/pdf/wa.pdf

Washington State Health Department:

http://www.doh.wa.gov/

Washington State Legislature:

http://www.leg.wa.gov/legislature/Pages/visitingthelegislature.aspx

WEST VIRGINIA

Exemption Forms Allowed: Medical

West Virgina Only Allows for Medical Exemptions Please follow these Guidelines:

http://www.vaclib.org/exempt/westvirginia.htm

West Virginia Exemption Coalition:

http://www.wvve.info/

West Virginia State Health Department:

http://www.wvdhhr.org/

West Virgina State Legislature:

http://www.legis.state.wv.us/

WISCONSIN

Exemption Forms Allowed: Medical, Philosophical, Religious

No Official Online Forms please follow these guidelines:

http://www.vaclib.org/exempt/wisconsin.htm

Wisconsin State Health Department:

http://www.dhs.wisconsin.gov/

Wisconsin State Legislature:

http://legis.wisconsin.gov/

WYOMING

Exemption Forms Allowed: Medical, Religious

Wyoming Exemption Forms:

http://www.vaclib.org/chapter/wyhome.htm

Wyoming State Health Department:

http://www.health.wyo.gov/

Wyoming State Legislature:

http://legisweb.state.wy.us/lsoweb/default.aspx