2019-2020 Louisiana 4-H Youth Development Program Statement of Exemption from Immunization-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name as the parent or guardian in the designated field. This is crucial for identifying who is claiming the exemption.
3. Next, provide your child's full name and date of birth in the respective fields. Accurate information here ensures proper processing of the exemption request.
4. Indicate your reason for exemption by checking either 'Medical' or 'Religious/Philosophical'. If you select 'Medical', remember to attach a note from your healthcare provider.
5. Fill in the name of your 4-H club and parish in the specified area to link your request with the appropriate local organization.
6. Finally, sign and date the form at the bottom. This confirms your request and understanding of potential exclusion during outbreaks.

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