Medical Immunization Exemption Form - colorado.gov 2026

1. Click ‘Get Form’ to open the Medical Immunization Exemption Form in the editor.
2. Begin by filling out the 'Student Information' section. Enter the student's last name, first name, and optional middle name. Provide their date of birth, gender, and contact details including email and phone number.
3. Next, complete the 'Parent/Guardian Completing This Form' section. Include your relationship to the student, your contact information, and check if you are an emancipated student or over 18 years old.
4. In the 'School/Licensed Child Care Facility Information' section, input the name of the school or facility along with its address and phone number. If not applicable, check the corresponding box.
5. Indicate which required vaccines are being declined by checking each relevant box. For each vaccine declined, list any medical contraindications in the provided space.
6. Finally, ensure that a physician or advanced practice nurse signs and dates the form before submission.

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