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Anna Maria College Health Services MEDICAL OR RELIGIOUS VACCINE EXEMPTION In accordance with the Massachusetts College Immunization Law (Massachusetts Department of Public Health, 105 CMR 220) and

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How to fill out immunization-waiver-request-form

01

Obtain a copy of the immunization waiver request form from the appropriate source (e.g. school, healthcare provider).

02

Fill out personal information including name, address, date of birth, and contact information.

03

Provide information on the immunizations being waived including the specific vaccines and the reason for the waiver request.

04

Sign and date the form to confirm the accuracy of the information provided.

05

Submit the completed form to the designated recipient (e.g. school nurse, healthcare provider) for review and processing.

Who needs immunization-waiver-request-form?

01

Individuals who are seeking an exemption from required immunizations may need to fill out an immunization waiver request form. This could include parents or guardians of children who are unable to receive vaccines due to medical reasons or personal beliefs, or individuals who are enrolling in school or participating in certain programs that require immunization records.

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What is immunization-waiver-request-form?

The immunization-waiver-request-form is a document used to request an exemption from immunization requirements for certain individuals.

Who is required to file immunization-waiver-request-form?

Individuals who are seeking an exemption from immunization requirements are required to file the immunization-waiver-request-form.

How to fill out immunization-waiver-request-form?

To fill out the immunization-waiver-request-form, individuals must provide their personal information, reason for requesting the waiver, and any supporting documentation.

What is the purpose of immunization-waiver-request-form?

The purpose of the immunization-waiver-request-form is to request an exemption from immunization requirements based on medical, religious, or philosophical reasons.

What information must be reported on immunization-waiver-request-form?

The immunization-waiver-request-form must include the individual's name, contact information, reason for requesting the waiver, and any supporting documentation.

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