Vaccine Exemption Forms

                                 LISTED IN ALPHABETICAL ORDER

ALABAMA
Exemption Forms Allowed: Medical, Religious
Alabama Temporary Medical Exemptions {pg75}
Alabama Religious Exemption IMM-52 {pg76}
Alabama Certificate of Immunization IMM-50
Alabama Exemption Form Process
Alabama Pet Rabies Vaccine Exemption Form

ALASKA 
Exemption Forms Allowed: Medical, Religious
Alaska Medical Exemption Form
Alaska Religious Exemption Form
Alaska Immunization Religious Exemption Form
Alaska Immunization Medical Vaccine Exemption Form
Alaska Immunization Religious Vaccine Exemption Form
Alaska Medical & Religious Exemption Forms {pgs.13&14}
Alaska Medical & Religious Exemption Forms {pgs.36&37}
State of Alaska Department of Correction Hepatitis B Exemption Form
Hepatitis B Vaccine Immunization Exemption Form
University of Alaska Anchorage Employee Hepatitis B Waiver

ARIZONA
Exemption Forms Allowed: Medical, Philosophical, Religious
Arizona Philosophical & Medical Exemption Form
Arizona Religious & Medical Exemption Form
Arizona Religious Exemption Higher Education

ARKANSAS
Exemption Forms Allowed: Medical, Philosophical, Religious
Arkansas Has No Online Exemption Forms Available
Request Exemption Forms email:
mailto:immunization.section@arkansas.gov
Arkansas Medical Form Information
Arkansas Philosophical & Religious Information
Arkansas Immunization Exemption Process{pgs.7&8}
AUSTRALIA
Exemption Forms Allowed: Medical
Australian Medical Contraindication Exemption Form
Australian Child Immunization Exemption Form
CANADA
Exemption Forms Allowed: Medical, Philosophical, Religious
Ontario Ministry of Health Conscience & Religious Exemption Form
CALIFORNIA
Exemption Forms Allowed: Medical, Philosophical
California Personal Beliefs Affidavit
California Exemption Affidavit Form
COLORADO
Exemption Forms Allowed: Medical, Philosophical, Religious
Colorado K-12 Public School Vaccine Exemption Forms
Colorado Certificate of Immunization College Exemption Form
Colorado College Certificate of Immunization Exemption Form
Colorado Hepatitis B Vaccine Exemption Waiver
Colorado Refusal of Vaccine Form
CONNECTICUT
Exemption Forms Allowed: Medical, Religious
Connecticut Medical Exemption Form
Connecticut Religious Exemption Form
Connecticut Vaccine Exemption Forms Multiple Languages
University of Connecticut Immunization Exemption Form
University of Connecticut School of Law Exemption Form
Connecticut College Religious Exemption Form
Central Connecticut University Exemptions & Waivers
DELAWARE 
Exemption Forms Allowed: Medical, Religious
Delaware Affidavit of Religious Belief Exemption Form
Delaware Vaccine Affidavit Outline & Process
University of Delaware Medical & Religious Exemptions
University of Delaware Hepatitis B Waiver
Vaccine Refusal Form
DISTRICT OF COLUMBIA
Exemption Forms Allowed: Medical, Religious
District of Columbia Has No Online Exemption Forms
FLORIDA
Exemption Forms Allowed: Medical, Religious
Florida’s Online Vaccine Enrollment Program to Obtain Exemptions
Sample Florida Medical Exemption Form DH-680
Sample Florida Religious Exemption Form DH-681
University of Florida Medical Vaccine Exemption Form
GEORGIA
Exemption Forms Allowed: Medical, Religious
Georgia Department of Human Resources Vaccine Opt Out Registry Form
Georgia State University Immunization Exemption Forms
Georgia State University Doctoral Program Exemption Form
Gainesville College Religious Exemption Form
Georgia Perimeter College Religious Exemption Form
Georgia’s Public Liberal Arts University Immunization Exemption Forms
Floyd College Georgia Certificate of Immunization Exemptions
Georgia University System Religious & Medical Exemptions
HAWAII
Exemption Forms Allowed: Medical, Religious
Hawaii Religious Vaccination Exemption Form
Hawaii Religious Vaccine Exemption Form
State of Hawaii Vaccine Refusal Exemption Form
State of Hawaii TB Waiver Form
IDAHO
Exemption Forms Allowed: Medical, Philosophical, Religious
Idaho Philosophical, Medical & Religious Exemption Forms
Idaho Philosophical, Medical & Religious Exemption Forms {Spanish}
Idaho Medical & Philosophical Vaccine Exemption Forms
Idaho Religious Vaccine Exemption Form
Idaho Online Opt Out Immunization Form
ILLINOIS
Exemption Forms Allowed: Medical, Religious
Illinois Religious Vaccine Exemption Form
Illinois Religious Exemption Form
Illinois University Edwardsville Religious Exemption Form
Illinois University Edwardsville Medical Exemption Form
Illinois Millikin University Religious Exemption Form
Illinois Aurora University Medical Immunization Exemption Form
INDIANA
Exemption Forms Allowed: Medical, Religious
Indiana Medical Vaccine Exemption Form 54648
Indiana Religious Exemption Form
Indiana Religious Vaccine Exemption Form
Valparaiso University Medical & Religious Exemptions
IOWA
Exemption Forms Allowed: Medical, Religious
Iowa IDPH Medical Vaccine Exemption Form
Iowa IDPH Religious Vaccine Exemption Form
Iowa Religious & Medical Vaccine Exemption Forms
Iowa Vaccine Exemption Forms 888-398-9696
KANSAS
Exemption Forms Allowed: Medical, Religious
Kansas Medical Vaccine Exemption Form
University of Kansas Immunization Waiver
KENTUCKY
Exemption Forms Allowed: Medical, Religious
Kentucky Certificate of Medical Exemption
Kentucky Certificate of Religious Exemption
Kentucky Vaccination Religious Affidavit
Kentucky Request for Religious Exemption Form
LOUISIANA
Exemption Forms Allowed: Medical, Philosophical, Religious
No Online School Enrollment Vaccine Exemption Forms Available
Only Available for State Colleges and Universities.
Louisiana Southern University Vaccine Exemption Forms
Louisiana Southeastern University Vaccine Exemption Request Form
Louisiana State University Immunization Exemption Request Form
Louisiana State University Eunice Immunization Exemption Request Form

MAINE
Exemption Forms Allowed: Medical, Philosophical, Religious
No Official Online PDF Forms Below is a Printable Version:
Maine Immunization Program:
http://www.maine.gov/dhhs/boh/ddc/immunization/index.shtml
Maine  State Health Department:
http://www.maine.gov/dhhs/
MARYLAND
Exemption Forms Allowed: Medical, Religious
Maryland Department of Health& Mental Hygiene Vaccine Exemption Forms:
No online form available Removed as of 3-16-2011
Maryland State Legislature:
http://mlis.state.md.us
Contact Maryland State Governors Office:
http://www.dhmh.maryland.gov/SitePages/Home.aspx
Maryland State Health Department:
http://www.dhmh.state.md.us/
MASSACHUSETTS
Exemption Forms Allowed: Medical, Religious
Immunization Exemptions & Guidelines:
http://www.mass.gov/eohhs/docs/dph/cdc/meningitis/regs-memo.pdf
Massachusetts State Health & Human Services:
http://www.mass.gov/?pageID=mg2homepage&L=1&L0=Home&sid=massgov2
MICHIGAN
Exemption Forms Allowed: Medical, Philosophical, Religious
Immunization Waiver Form:
http://www.momvaccines.org/SS_Imm_Wavier_March_2011%5B1%5D.pdf
Michigan State Health Services:
http://www.michigan.gov/mdch
MINNESOTA
Exemption Forms Allowed: Medical, Philosophical, Religious
Minnesota’s School Immunization Law Exemption Provision:
http://www.health.state.mn.us/divs/idepc/immunize/laws/exemption.html
Minnesota State Health Department:
http://www.health.state.mn.us/
MISSISSIPPI
Exemption Forms Allowed: Medical
No Official Online form
Your written form must be signed by the District Health Officer:
Mississippi immunization Schedule & Exemption Procedure:
http://www.msdh.state.ms.us/msdhsite/_static/resources/2029.pdf
Mississippi State Legislature:
http://billstatus.ls.state.ms.us/
Mississippi State Health Department:
http://www.msdh.state.ms.us/
MISSOURI
Exemption Forms Allowed: Medical, Religious
Missouri School Vaccine Exemption Form:
https://www.sos.mo.gov/adrules/csr/previous/19csr/19csr699/19c20-28a.pdf
Missouri State Legislature:
www.moga.mo.gov
Missouri State Health Department:
http://health.mo.gov/index.php
MONTANA
Exemption Forms Allowed: Medical, Religious
Montana Religious Exemption Form:
http://www.gallatingatewayschool.com/media/pdf/forms/ReligiousExemptForm.pdf
Montana State Legislature:
http://leg.mt.gov/css/default.asp
Montana State Health Department:
http://www.dphhs.mt.gov/
NEBRASKA
Exemption Forms Allowed: Medical, Religious
Refusal of Immunization of Student for Religious Reasons:
http://dhhs.ne.gov/publichealth/Documents/MedicalExemption.pdf
Refusal of Immunization on Medical ground:
Nebraska State Legislature:
http://nebraskalegislature.gov/

Nebraska Health and Human Services Division:
www.hhs.state.ne.us
NEVADA
Exemption Forms Allowed: Medical, Religious
No Official Online Forms Please read the nrs392Sec437 listed below to learn your rights:
http://www.leg.state.nv.us/NRS/NRS-392.html#NRS392Sec437
Nevada Health and Human Services Division:
http://health.nv.gov/
Nevada State Legislature:
http://www.leg.state.nv.us/
NEW HAMPSHIRE
Exemption Forms Allowed: Medical, Religious
No official online forms please see the State Constitution below to know your rights:
http://hebinec.cwahi.net/vaccine-exemption-forms-for-nh.php
New Hampshire State Legislature:
http://gencourt.state.nh.us/
New Hampshire State Health Department:
http://www.dhhs.nh.gov/
NEW JERSEY
Exemption Forms Allowed: Medical, Religious
No official online forms:
Make sure to get written forms notarized.
Religious Exemption Procedure:
http://www.vaclib.org/chapter/cherubs.htm
New Jersey State Legislature:
http://www.njleg.state.nj.us/
New Jersey State Health Department:
http://www.state.nj.us/health/
NEW MEXICO
Exemption Forms Allowed: Medical, Philosophical, Religious
New Mexico Exemption Forms:
New Mexico State Health Department:
http://www.health.state.nm.us/
NEW YORK
Exemption Forms Allowed: Medical, Religious
No Online Forms Please follow these guidelines:
http://www.vaclib.org/exempt/newyork.htm
New York State Assembly:
http://assembly.state.ny.us/
New York State Health Department:
http://www.health.state.ny.us/
New York Health Department Immunization Schedule:
http://www.health.state.ny.us/prevention/immunization/
NORTH CAROLINA
Exemption Forms Allowed: Medical, Religious
Religious Exemption Forms:
http://www.vaclib.org/exempt/northcarolina.htm#letters
North Carolina State Health Department:
http://ncdhhs.gov/dph/wch/
NORTH DAKOTA
Exemption Forms Allowed: Medical, Philosophical, Religious
North Dakota Certificate of Immunization & Exemptions:
http://www.ndhealth.gov/Immunize/Documents/Providers/Forms/CertificateofImmunization.pdf
North Dakota State Department of Health:
http://www.ndhealth.gov/
North Dakota Legislative Branch:
http://www.legis.nd.gov/
OHIO
Exemption Forms Allowed: Medical, Philosophical, Religious
No Official Online PDF Forms:
Ohio State Health Department:
http://www.odh.ohio.gov/odhPrograms/dis/immunization/immindex1.aspx
Ohio General Assembly:
http://www.legislature.state.oh.us/
 OKLAHOMA
Exemption Forms Allowed: Medical, Philosophical, Religious
Oklahoma Vaccine Exemption Forms make sure to get Notarized:
http://www.unhinderedliving.com/exemptionform.html
Oklahoma State Health Department:
http://www.ok.gov/health/
OREGON
Exemption Forms Allowed: Medical, Religious
No Online Forms Write Oregon Health Department follow these guidelines:
http://www.vaclib.org/exempt/oregon.htm
Oregon State Legislature:
http://www.leg.state.or.us/

Oregon State Health Department:
http://public.health.oregon.gov/Pages/Home.aspx
PENNSYLVANIA
Exemption Forms Allowed: Medical, Religious
Pennsylvania Medical & Religious Exemption Form:
http://www.unhinderedliving.com/Vaccine.jpg
Pennsylvania State Health Department:
http://www.portal.health.state.pa.us/portal/server.pt/community/department_of_health_home/17457
Pennsylvania General Assembly:
http://www.legis.state.pa.us/
RHODE ISLAND
Exemption Forms Allowed: Medical, Religious
Rhode Island School Immunization Rules & Exemptions:
http://www2.sec.state.ri.us/dar/regdocs/released/pdf/DOH/DOH_3523.pdf
http://www2.sec.state.ri.us/dar/regdocs/released/pdf/DOH/DOH_3582.pdf
Rhode Island Health Department:
http://www.health.state.ri.us/
Rhode Island General Assembly:
http://www.rilin.state.ri.us/
SOUTH CAROLINA
Exemption Forms Allowed: Medical, Religious
No Official Online Form contact your Regional Health Office:
http://www.scdhec.gov/health/countymap.htm
South Carolina Health Department:
http://www.scdhec.gov/index.htm
South Carolina General Assembly:
http://www.scstatehouse.gov/
SOUTH DAKOTA
Exemption Forms Allowed: Medical, Religious
No Online Vaccine Forms Contact State Health Department:
http://doh.sd.gov/Immunize/School.aspx
South Dakota State Health Department:
http://www.sd.gov/
South Dakota Legislature:
http://legis.state.sd.us/index.aspx
TENNESSEE
Exemption Forms Allowed: Medical, Religious
No Official Online Forms Follow these Guidelines:
http://www.vaclib.org/exempt/tennessee.htm
Tennessee State Health Department Immunizations & Exemptions:
http://health.state.tn.us/Ceds/immunization.htm
Tennessee General Assembly:
http://www.legislature.state.tn.us/
Tennessee State Government:
http://www.state.tn.us/
TEXAS
Exemption Forms Allowed: Medical, Philosophical, Religious
No Online Texas Vaccine Exemption Forms follow these guidelines
Make Sure to get written forms Notarized:
http://www.vaclib.org/exempt/texas.htm
Texas Vaccine Exemption & Regulations:
http://www.dshs.state.tx.us/immunize/school/default.shtm#infoforschoolchildcare
Texas Health & Human Services:
http://www.hhs.state.tx.us/
Texas State Legislature:
http://www.capitol.state.tx.us/
UTAH
Exemption Forms Allowed: Medical, Philosophical, Religious
Utah Immunization Exclusion & Exemptions:
http://health.utah.gov/epi/cdepi/Imm_Exclusion_FS.pdf
Utah Immunization Guidelines Exemption Forms:
http://www.immunize-utah.org/provider/school/2011-2012%20Immunization%20Guidebook.pdf
Utah State Health Department:
http://health.utah.gov/
Utah State Legislature:
http://le.utah.gov/
VERMONT
Exemption Forms Allowed: Medical, Philosophical, Religious
Vermont School Vaccine Exemption Forms:
http://healthvermont.gov/hc/imm/documents/School_Immunization_Exemption_Form.pdf
Vermont State Legislature:
http://www.politicsol.com/govsites/state-legislatures/vt.html
Vermont State Health Department:
http://healthvermont.gov/

VIRGINIA
Exemption Forms Allowed: Medical, Religious
Virginia Religious Exemption Form:
http://www.vdh.virginia.gov/epidemiology/immunization/documents/cre_1.pdf
West Virginia Vaccination Exemptions:
http://www.wvve.info/index.html
Virginia State Health Department:
http://www.vdh.state.va.us/
Virginia General Assembly:
http://legis.state.va.us/
WASHINGTON
Exemption Forms Allowed: Medical, Philosophical, Religious
Washington Exemption Forms:
http://www.vaclib.org/pdf/wa.pdf
Washington State Health Department:
http://www.doh.wa.gov/
Washington State Legislature:
http://www.leg.wa.gov/legislature/Pages/visitingthelegislature.aspx

WEST VIRGINIA
Exemption Forms Allowed: Medical
West Virgina Only Allows for Medical Exemptions Please follow these Guidelines:
http://www.vaclib.org/exempt/westvirginia.htm
West Virginia Exemption Coalition:
http://www.wvve.info/
West Virginia State Health Department:
http://www.wvdhhr.org/
West Virgina State Legislature:
http://www.legis.state.wv.us/
WISCONSIN
Exemption Forms Allowed: Medical, Philosophical, Religious
No Official Online Forms please follow these guidelines:
http://www.vaclib.org/exempt/wisconsin.htm
Wisconsin State Health Department:
http://www.dhs.wisconsin.gov/
Wisconsin State Legislature:
http://legis.wisconsin.gov/
WYOMING
Exemption Forms Allowed: Medical, Religious
Wyoming Exemption Forms:
http://www.vaclib.org/chapter/wyhome.htm
Wyoming State Health Department:
http://www.health.wyo.gov/
Wyoming State Legislature:
http://legisweb.state.wy.us/lsoweb/default.aspx