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Kentucky vaccine exemption form

Ky vaccine exemption form 2026

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The document is an Immunization Religious Exemption Form that allows parents or guardians to exempt their child from vaccinations due to religious beliefs. It outlines the importance of immunizations in preventing disease outbreaks and requires a written statement of objection. By signing, the parent acknowledges understanding the risks associated with not vaccinating and permits sharing of immunization records as required by law.

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Click ‘Get Form’ to open the ky vaccine exemption form in our editor.
Begin by entering the Patient ID number and Patient Name at the top of the form. Ensure that all information is accurate for proper identification.
In the section labeled 'I swear or affirm that I object to having my child...', fill in your child's name and date of birth. This personalizes the exemption request.
Check the boxes next to each vaccine you are exempting your child from. Make sure to review the list carefully to ensure all relevant vaccines are included.
Provide a reason for the exemption in the designated space. This statement should reflect your religious beliefs regarding vaccinations.
Enter your name as a parent or guardian, and sign where indicated. If applicable, have a physician or authorized individual sign as well, along with their date signed.

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kentucky religious exemption form

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