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

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  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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Twenty-nine states and Washington D.C. allow exemptions for people who have religious objections to immunizations. Fourteen states allow exemptions for either religious or personal reasons. Two states, Louisiana and Minnesota, do not specify whether the non-medical exemption must be for religious or personal reasons.
(American Academy of Pediatrics, 2022a) Parents are the primary decision makers for childrens vaccination in the U.S.: 42 states require parental consent before a child receives a COVID-19 vaccine.
Louisiana maintains its public school immunization requirements but allows parents to opt out for any reason. A new 2024 law requires that any communication about vaccine requirements must also include exemption information.
Although Louisiana has vaccination requirements for children entering daycare or school, these requirements can be waived. The childs parent or guardian may request an exemption in writing for medical or religious/philosophical reasons.
All states allow exemptions from school immunization requirements for children who are unable to receive vaccines for medical reasons. State laws vary regarding non-medical exemptions, for religious or personal reasons. Personal exemptions are also referred to as philosophical exemptions by some states.

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Every state has laws that require children to get certain vaccines before they can go to school or daycare. Yet parents may be able to opt out of one or more vaccines for medical, religious, or personal reasons. Vaccine exemption laws vary from state to state. Some states make it easier to avoid vaccines than others.
Please initial next to each of the statements below: I request a reasonable accommodation due to my sincere religious beliefs. I understand and assume the risks of non-vaccination. I accept full responsibility for my health, thus removing liability from the City to the required vaccinations.

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