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  • Vaccines For Children Program Provider Agreement - Nc ...

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D By Nombre y Direcci n del Centro M dico 2 Tdap Td Tdap Pneumococcal Neumococica Influenza Influenza Other Otra Allergies or Medical Notes / Alergias o Notas m dicas: DTaP/DT/DTP Diphtheria, Tetanus, Pertussis (whooping cough)/Difteria, T tano,Tosferina (tos convulsiva) Hib Haemophilus influenzae type B/Influenza hom fila Tipo B Poli.

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Medical exemptions for required immunizations will only be granted upon submission of either a Medical Exemption Statement (DHHS 3987) or Physicians Request for Medical Exemption (DHHS 3995). Both of these exemptions require a signature by a Physician in North Carolina.

What exemptions to immunizations are allowed in North Carolina? North Carolina law provides for two types of exemptions from required immunizations. They are medical and religious. Learn more about these exemptions, and the process for requesting an exemption for your children.

Since 1994, parents have been protecting their children through the VFC Program. This pro- gram provides free vaccines to children whose parents need help paying for them.

North Carolina law requires all children in the state to receive certain immunizations. Records are checked when children enter school or child care, so ask your pediatrician for a copy of your child's vaccine record next time you visit the doctor.

North Carolina requires all children — with some exceptions — to be vaccinated before attending child care or school, whether public or private. If students don't have the required vaccinations, they won't be allowed at school.

There is no form for requesting religious exemptions in North Carolina. To claim a religious exemption, the parent or person requesting the exemption must write a statement of their religious objection to immunization, including the name and date of birth of the person for whom the exemption is being requested.

North Carolina General Statutes 130A-157 Religious Exemption Upon submission of a written statement of the bona fide religious beliefs and opposition to the immunization requirements,the person may attend the college, university, school or facility without presenting a certificate of immunization.

I, __________________________________ am requesting a religious exemption from vaccination against the disease(s) or condition(s) marked below. I understand that this exemption is allowed solely for sincerely held religious beliefs and not for political, social, or other personal views.

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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232