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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2014 | 4.8 Satisfied (101 Votes) |
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All children under the age of six on a CalWORKs grant must have up-to-date immunizations.
Parents can request an exemption from providing proof of immunizations if they have a valid reason, referred to as 'good cause.'
Parents must fill out the form and indicate which child is claiming a 'good cause' exemption by circling the appropriate number.
The form provides specific reasons for requesting an exemption, including medical advice, transportation issues, and language barriers.
For certain exemptions, such as medical reasons or incorrect records, parents must provide additional documentation to support their claims.
The form requires a declaration under penalty of perjury that the information provided is true.
The form includes sections for client and worker contact information to facilitate communication regarding the request.
