Maryland vaccine exemption form: Fill out & sign online

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Click ‘Get Form’ to open the vaccine exemption letter in the editor.
Begin by entering your name in the designated field where it states 'I,_______, as the parent, guardian or person in loco parentis of the child ________.' Ensure that you accurately fill in your child's name as well.
Next, indicate which vaccines you are exempting by checking the appropriate boxes next to each vaccine listed. This includes Diphtheria, Tetanus, Pertussis, Polio, Hepatitis B, Smallpox, Measles, Mumps, Rubella, Haemophilus influenzae type b, Varicella, and Anthrax.
In the section regarding your rights under Maryland statute § 7-403, review and ensure that all information is correct before signing. You will need to provide your signature and date at the bottom of the form.
Finally, if required, have a notary public sign and seal the document on the specified line to complete the process.

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