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Click ‘Get Form’ to open the religious exemption form in the editor.
Begin by entering the name of your religious institution in the designated field. Ensure that it reflects any religious modifiers as required.
Fill in the physical address of your institution, including city, state, and ZIP code. If available, provide a telephone number, fax number, email, and website.
If your mailing address differs from the physical address, complete that section with accurate details.
Identify the person executing the sworn affidavit by entering their name and title. This individual must hold an official position within your institution.
Review and affirm each statement in the sworn affidavit section. Ensure all information is true and accurate before signing.
Complete the notarization section by having a notary public witness your signature and provide their details.
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California removed its personal and religious exemption option in 2015. Parent/guradian must complete an online educational module to receive a non-medical exemption. Connecticut removed its religious exemption option in 2021.
How to file a religious exemption in Florida?
A request for a religious exemption from immunization requirements must be presented to the facility/school on the Department of Healths Religious Exemption From Immunization (DH 681 Form).
What are religious reasons for not being vaccinated?
Objection to vaccination was also related to: faith in divine protection and healing for Protestants, Catholics, Jewish and Muslims (10); the use of aborted fetal cells for vaccines production among Amish and Catholic communities (including during the COVID-19 outbreak when Senior Catholic leaders from the US and
religious vaccine exemption form
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Form CMS-2552-10, which contains instructions for the completion of exemption is granted, cost reimbursement continues through the end of the exemption.
I affirm and attest that my personally held religious beliefs and practices or personal tenets preclude me from receiving immunization(s), including those
Aug 28, 2025 Form DH 681, Religious Exemption From Immunization, is issued if immunizations are in conflict with the religious tenets and practices of the
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