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Hawaii department of health vaccine exemption form 2026
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- Click ‘Get Form’ to open the Hawaii Department of Health Vaccine Exemption Form in our platform.
- Begin by entering your name as the parent, guardian, or person in loco parentis in the designated field.
- Next, input your child's name in the corresponding section to certify that vaccination is against your religious beliefs.
- Select the vaccines for which you are requesting an exemption by checking the appropriate boxes. Options include Diphtheria, Tetanus, Pertussis, and others listed.
- Sign and date the form at the bottom where indicated. Ensure that both parents sign if applicable.
- Finally, have the form notarized as required before submitting it to your child’s school administrator.
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No other exemptions are allowed by the State. All schools in Hawaii are required to submit an Immunization Assessment Report (EPI 12A or EPI 12B) to the HawaiiRead more
. I understand that a request for religious exemption based on objections to specific vaccines. Initials will not be granted. I understand the benefitsRead more
May 9, 2008 * Persons who claimed exemption from vaccination because of religious or personal beliefs. Updated weekly from reports to the InfluenzaRead more