Get Religious Exemption Certificate - Rhode Island Department Of ...

This guide provides clear and comprehensive instructions on completing the Religious Exemption Certificate required by the Rhode Island Department of Health. Whether you are a parent, guardian, or a student 18 years or older, these steps will help you fill out the form correctly and efficiently.

Follow the steps to complete the Religious Exemption Certificate online.

1. Click ‘Get Form’ button to obtain the Religious Exemption Certificate and open it in your online editor.
2. Section 1: Enter the student information in the provided fields. Include the student’s name, date of birth, grade, street address, city, zip code, and phone number. Additionally, fill in the healthcare provider's name and address, including their phone number.
3. Section 2: This section needs to be completed by the parent or guardian or the student if they are 18 years old or older. Indicate the vaccines from the provided list for which you are requesting an exemption based on religious beliefs by checking the appropriate boxes.
4. Ensure that the person completing the form initials next to each statement after reading the Vaccine Information Statements. This confirms understanding of the benefits and risks associated with the vaccines indicated.
5. In the signature area, the parent or guardian or the student (if 18 years or older) should provide their signature and the date of signing, acknowledging the decision.
6. Section 3 is for school official use only. Ensure that the school nurse and school administrative head sign and date the form accordingly.
7. Review all provided information for accuracy. Once complete, you can save changes, download, print, or share the form as required.

Complete your Religious Exemption Certificate online today!