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Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.

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If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.

We protect your documents and personal data by following strict security and privacy standards.
California removed its personal and religious exemption option in 2015. Parent/guradian must complete an online educational module to receive a non-medical exemption. Connecticut removed its religious exemption option in 2021.
A Certificate of Religious Exemption can only be issued by a county health department. The parent or legal guardian must submit a written objection and receive education on the consequences of not immunizing their child.
There are a number of ways that someone can prove strongly held religious beliefs that getting the vaccine would contradict. Writing a formal letter requesting exemption. Getting a close friend, family member or fellow member of the clergy to write a letter. Filling out and submitting a religious exemption request form:
You must request a vaccine exemption affidavit form by submitting a request through the U.S. Postal Service, commercial carrier, fax, or online. Phone and email requests are not accepted. Personal pick up at DSHS is not permitted. ALL affidavit forms will be mailed to you via the U.S. Postal Service.
A Certificate of Religious Exemption can only be issued by a county health department. The parent or legal guardian must submit a written objection and receive education on the consequences of not immunizing their child.
Objection to vaccination was also related to: faith in divine protection and healing for Protestants, Catholics, Jewish and Muslims (10); the use of aborted fetal cells for vaccines' production among Amish and Catholic communities (including during the COVID-19 outbreak when Senior Catholic leaders from the US and ...
Pediatricians and other health care providers may decide it is in their best interest to formally document a parent's refusal to accept vaccinations/immunizations for a minor child. This form, which should not be considered a legal document without advice from a lawyer, may be used for such documentation.
A religious exemption for daycare and school-aged children can be obtained through your local county health department.
California removed its personal and religious exemption option in 2015. Parent/guradian must complete an online educational module to receive a non-medical exemption. Connecticut removed its religious exemption option in 2021.