Modified American Academy of Pediatrics Refusal of Vaccination Form - AAP
Understanding this form
The Modified American Academy of Pediatrics Refusal of Vaccination Form, commonly known as the Refusal of Vaccination Form, allows parents or guardians to formally decline specific vaccinations recommended for their child. This form serves as a record of the refusal and ensures that parents understand the implications of their decision. It is essential for maintaining accurate health records and differentiates from other vaccination forms that may simply document consent or intent to vaccinate.
Key parts of this document
- Child's name and ID: Basic identification for the child for whom vaccinations are being declined.
- Parent/guardian details: Names of the parents or guardians making the refusal.
- Healthcare provider information: Details of the child's healthcare provider recommending vaccination.
- Vaccine information: Sections to indicate which vaccines are recommended, declined, and specific dates.
- Signature and date fields: Spaces for the parent/guardian and witness signatures, along with the date of signing.
- Acknowledgment section: Confirmation that the parent/guardian has read and understood the implications of the refusal.
State-specific compliance details
This is a general form suitable for multiple states. Review and modify it as needed to reflect your jurisdiction’s rules.
When to use this document
This form should be used when a parent or guardian decides not to administer one or more vaccines that a healthcare provider recommends for their child. It is particularly relevant in situations where personal beliefs, health concerns, or educational requirements may influence the decision to refuse vaccination. The form serves as an official acknowledgment of the refusal and the potential risks involved.
Intended users of this form
- Parents or guardians of minors who wish to decline vaccinations.
- Individuals seeking to keep formal documentation of their refusal to vaccinate.
- Families who have concerns about specific vaccines or vaccination schedules.
How to prepare this document
- Enter the child's name and identification number at the top of the form.
- Fill in the names of the parents or guardians refusing the vaccination.
- Provide the name of the child's healthcare provider recommending vaccination.
- Indicate the vaccines being recommended and state whether each is accepted or declined.
- Sign and date the form, ensuring to have a witness if required.
- Review the acknowledgment section to confirm understanding of the refusal's implications.
Is notarization required?
Notarization is not commonly needed for this form. However, certain documents or local rules may make it necessary. Our notarization service, powered by Notarize, allows you to finalize it securely online anytime, day or night.
Common mistakes to avoid
- Failing to provide complete information about the child and parent/guardian.
- Not signing or dating the form, which can invalidate the refusal.
- Overlooking the acknowledgment section, which is crucial for legal purposes.
Advantages of online completion
- Immediate access to a legally vetted template drafted by licensed attorneys.
- Editability allows customization to meet specific needs before printing.
- Secure storage of documents ensures peace of mind regarding the refusal's documentation.
Legal use & context
- This form serves as a formal record of the parent's decision to decline vaccinations, which can be important for legal and medical records.
- While the form is widely recognized, its acceptance may vary across different states and educational institutions.
- Understanding the local legal context is crucial for ensuring the form is enforceable.
Summary of main points
- The Modified American Academy of Pediatrics Refusal of Vaccination Form helps document a parent's choice to refuse vaccinations.
- It is important to understand local laws when using this form.
- Completing the form accurately ensures compliance and protects the rights of the child and guardian.
Form popularity
FAQ
How do I get a copy of the Interim Vaccination Objection Form? The Interim Vaccination Objection Form for Enrolment in NSW Child Care Centres is only available from the NSW Health website. Download and print a copy from the website and take it with you to your medical practitioner or authorised nurse immuniser.
Parents of children enrolling in primary or secondary schools must be asked for an approved immunisation certificate, but if this is not available, the student may still be enrolled, subject to required procedures (e.g. unvaccinated children may be excluded from school for the duration of an outbreak of a vaccine-
Vaccines offered through the national immunisation programme in the UK are not mandatory. Vaccinations are also not currently mandatory in the UK during a pandemic. Medical and ethical opinion is divided on the introduction of immunisation policies that involve some degree of coercion (such as fines).
Parents who do not want to vaccinate their children attending school have three options: obtain a medical exemption to vaccinations, enroll in homeschooling or independent study without classroom instruction, or have their children evaluated and enrolled in special education services.
As mentioned earlier, delay in vaccination is manageable. Having said that, it is important to administer deferred doses as soon as it is feasible. Missed vaccination puts the child at risk of contracting the disease the vaccine was meant to protect against.
2265 6 yrs: 2 doses (2265 7 days) If interval since last dose 2265 6 weeks restart primary series Not recommended 2-5 yrs: 3 doses > 6 yrs: 2 doses 2-5 yrs: every 6 months. If booster is delayed > 6 months the primary series must be repeated.
Talk to their doctor or read about the benefits of vaccines and the risks of not vaccinating their children. Get a signature from a local health department official. Write a letter that explains their reasons for refusing vaccines. Renew their exemption form every year.
To claim an exclusion for reasons of conscience, including a religious belief, the child's parent, legal guardian, or a student 18 years of age or older must present to the school or child-care facility a completed, signed and notarized affidavit on a form provided by the department stating that the child's parent,
Can I refuse my child's vaccinations? Vaccines are not mandatory in the UK and you should be asked for your consent before each vaccination. However, it's important to remember that vaccines will protect your child for many years against a range of serious illnesses.
