IMMUNIZATION WAIVER FORM - summit-academy.com 2026

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The document is an Immunization Waiver Form from the Michigan Department of Community Health, outlining the requirements for vaccinations for children entering school or certain programs. It emphasizes the importance of immunizations in preventing disease outbreaks and provides instructions for parents or guardians who wish to exempt their child from vaccinations due to religious or philosophical reasons. The form requires personal information and a written statement of objection, acknowledging the risks associated with not vaccinating.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your child's full name and birth date in the designated fields. This information is crucial for identifying the child associated with the waiver.
In the section provided, check off the vaccines you are opting out of. Ensure that you clearly indicate your objections to each specific vaccine listed.
Provide a written statement explaining your religious or philosophical reasons for opting out. This should be concise yet clear.
Fill in your name as the parent or guardian, along with your address and telephone number. If applicable, include details for any preschool program or daycare center.
Finally, sign and date the form at the bottom to validate your request. Make sure all information is accurate before submission.

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