Get the free Religious Exemption Form - my kids, my choice

REQUEST FOR RELIGIOUS EXEMPTION TO IMMUNIZATION FORM PARENT/GUARDIAN STATEMENT Name of Student Identification Number Name of Parent(s)/Guardian(s) School District and Building Name This form is for

This form is also used by the Department for the purpose of determining the validity of a religious exemption from the requirements of Public Health Law Immunization Requirements. The Department's application form can be seen at. If you are applying for an exemption that your child will qualify for at a later date, you should complete this form first. Your parent(s)/guardian must provide the following information: Date of birth. Address where the medical certificate was signed Current city, State, ZIP code, and date the exemption will begin (or if the exemption will become effective on a later date) Medical Certificate Number Name of physician's name Date the medical certificate was signed (if any) A completed form [PDF] requesting an exemption to Public Health Law immunization requirements for your child. If you are filing an exemption based on philosophical, political, scientific, or sociological views of the applicants or parents, please provide additional supporting documentation when completing the form. Your parent(s)/guardian must provide the following information: Age. Age ranges: birth to 18 years old Applicant's home address at the time of application Parents' names Address of principal residence (if applicable) The names of all other persons known to be members of the applicant's household at the time of application If the exemption become effective on a later date, a signed, dated statement that the written request was received by the Department on or before the applicable exemption date. The applicant must include the completed medical exemption request form and any other related supporting documentation with the completed exemption application. Name of physician's name Date the medical certificate was signed (if any) A completed form [PDF] requesting an exemption to Public Health Law immunization requirements for your child. If you are filing an exemption that your child will qualify for at a later date, you should complete this form first. Your parent(s)/guardian must provide the following information: If the medical exemptions will be approved, the applicant's name, address, and date of birth will be listed on the child's exemption form. If the exemption will not be approved, the application will be denied.

For pdfFiller’s FAQs

What is religious exemption form?

A religious exemption form is a document that allows individuals to request exemption from certain requirements or obligations based on their religious beliefs.

Who is required to file religious exemption form?

Individuals who have religious beliefs that conflict with certain requirements or obligations may be required to file a religious exemption form.

How to fill out religious exemption form?

To fill out a religious exemption form, individuals need to provide their personal information, describe their religious beliefs and explain how these beliefs conflict with specific requirements or obligations.

What is the purpose of religious exemption form?

The purpose of a religious exemption form is to provide individuals with a mechanism to request exemption from certain requirements or obligations based on their religious beliefs.

What information must be reported on religious exemption form?

The information that must be reported on a religious exemption form typically includes personal details, the specific requirements or obligations from which exemption is being sought, and a description of the religious beliefs that conflict with these requirements.

When is the deadline to file religious exemption form in 2023?

The deadline to file a religious exemption form in 2023 may vary depending on the specific requirements or obligations and the governing authority. It is recommended to consult the relevant guidelines or authorities for the exact deadline.

What is the penalty for the late filing of religious exemption form?

The penalty for the late filing of a religious exemption form can vary depending on the governing authority and the specific requirements or obligations. It is advisable to consult the relevant guidelines or authorities to determine the potential penalty for late filing.

Where do I find religious exemption form?

It's simple with pdfFiller, a full online document management tool. Access our huge online form collection (over 25M fillable forms are accessible) and find the religious exemption form in seconds. Open it immediately and begin modifying it with powerful editing options.

How do I edit religious exemption form on an iOS device?

You can. Using the pdfFiller iOS app, you can edit, distribute, and sign religious exemption form. Install it in seconds at the Apple Store. The app is free, but you must register to buy a subscription or start a free trial.

How do I complete religious exemption form on an iOS device?

In order to fill out documents on your iOS device, install the pdfFiller app. Create an account or log in to an existing one if you have a subscription to the service. Once the registration process is complete, upload your religious exemption form. You now can take advantage of pdfFiller's advanced functionalities: adding fillable fields and eSigning documents, and accessing them from any device, wherever you are.