IMMUNIZATION WAIVER FORM - summit-academy.com 2026

1. Click ‘Get Form’ to open it in the editor.
2. 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.
3. 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.
4. Provide a written statement explaining your religious or philosophical reasons for opting out. This should be concise yet clear.
5. 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.
6. 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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