Student Name: Date of Birth: / / Refer to the Document Cover Page for instructions on submitting this form. Immunization Record/Statement of Exemption Immunization information is required for all.
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How to fill out the Immunization Record/Statement of Exemption - Connections Academy online
This guide provides clear, step-by-step instructions to assist users in filling out the Immunization Record/Statement of Exemption for Connections Academy. Completing this form accurately is essential for students entering public school.
Follow the steps to complete the form online.
- Click ‘Get Form’ button to access the Immunization Record/Statement of Exemption and open it in the designated online editor.
- Enter the student’s name and date of birth in the specified fields. Ensure that the information is accurate.
- Fill in the street address, city, state, and ZIP code of the student’s residence.
- For the immunization section, this must be completed by a healthcare provider. Ensure that they fill in the required vaccines and corresponding doses administered.
- If applicable, select the appropriate exemption statement based on physical condition or personal beliefs. Complete the related fields as required.
- Review all entered information for accuracy. Make any necessary corrections.
Complete your immunization documents online today for a smooth enrollment process.
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Get answers to your most pressing questions about US Legal Forms API.
Is it illegal to not vaccinate your child in Indiana?
No. Indiana law only allows religious objection or medical exemption.
How do I get a vaccine exemption in Nevada?
How can I submit a medical or religious exemption form? Someone requesting an immunization exemption due to medical conditions or religious beliefs must: 1. Submit a written statement on a form provided by the Division of Public and Behavioral Health of the Department of Health and Human Services.
What is the religious exemption code in Indiana?
VACCINE EXEMPTION FORM religious beliefs. IC § 20-34-3-2.
What is the vaccination exemption pursuant to Indiana Code 20 34 3 2?
(a) Except as otherwise provided, a student may not be required to undergo any testing, examination, immunization, or treatment required under this chapter or IC 20-34-4 when the child's parent objects on religious grounds.
Do Indiana schools require COVID vaccine?
2 doses are required for all grades Pre-K through 12. COVID-19: COVID-19 vaccine is recommended for all students five years of age and older per CDC and FDA's Emergency Use Authorization.
What vaccines are mandatory in Indiana?
Indiana 2021-2022 Required and Recommended School Immunizations printable list GradeRequired Pre-K 3 Hepatitis B 4 DTaP (Diphtheria,Tetanus & Pertussis) 3 Polio K-5th grade 3 Hepatitis B 5 DTaP 4 Polio 6th-11th grade 3 Hepatitis B 5 DTaP 4 Polio 2 Varicella 12th grade 3 Hepatitis B 5 DTaP 4 Polio 2 Varicella
What is the Indiana Code for religious exemption?
Code § 21-40-5-6. Section 21-40-5-6 - Religious objections (a) Except as otherwise provided, a student may not be required to undergo testing, examination, immunization, or treatment required under this chapter when the student objects on religious grounds.
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