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Child Name:___ Child Date of Birth:___Personal Beliefs Exemption Form Kindergarten 12th Grade Only Arizona Department of Health Services (ADDS) strongly supports immunization as one of the easiest

How to fill out affidavit of immunization exemption

How to fill out affidavit of immunization exemption

1. Obtain the affidavit of immunization exemption form from your state's health department or website.
2. Fill out your personal information at the top of the form, including your name, address, and date of birth.
3. Indicate the reason for requesting the exemption, such as medical, religious, or philosophical beliefs.
4. Have the form signed by a medical professional, notary public, or other authorized individual as required by your state's regulations.
5. Submit the completed form to the appropriate authority, such as your child's school or daycare center.

Who needs affidavit of immunization exemption?

1. Individuals who are seeking an exemption from immunization requirements for medical, religious, or philosophical reasons.

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What is affidavit of immunization exemption?

An affidavit of immunization exemption is a legal document that individuals can file to formally request an exemption from required immunizations for school or childcare based on specific grounds, such as medical, religious, or philosophical beliefs.

Who is required to file affidavit of immunization exemption?

Parents or guardians of children who are attending school or childcare facilities and wish to exempt their children from mandatory vaccinations are required to file an affidavit of immunization exemption.

How to fill out affidavit of immunization exemption?

To fill out an affidavit of immunization exemption, individuals must provide personal details such as the child's name, date of birth, address, and the specific reason for the exemption, along with any supporting documentation as required by state laws.

What is the purpose of affidavit of immunization exemption?

The purpose of the affidavit of immunization exemption is to allow individuals to decline mandatory vaccinations for their children while still complying with state laws regarding school or childcare enrollment.

What information must be reported on affidavit of immunization exemption?

The affidavit must typically include the child's name, date of birth, parent or guardian's name, the specific immunizations being exempted, the reason for the exemption, and may require a signature or notarization.