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Medical Immunization Exemption Form - colorado.gov 2025

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The document is a Medical Exemption Form for immunization required by Colorado law for students attending schools and child care facilities. It outlines the necessity for vaccinations against specific diseases, the process to file an exemption, and the implications of having an exemption during disease outbreaks. The form requires detailed student and guardian information, as well as medical contraindications for declined vaccines.

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Click ‘Get Form’ to open the Medical Immunization Exemption Form in the editor.
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.
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.
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.
Indicate which required vaccines are being declined by checking each relevant box. For each vaccine declined, list any medical contraindications in the provided space.
Finally, ensure that a physician or advanced practice nurse signs and dates the form before submission.

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Can I get in trouble for not vaccinating my child?

Refusal to have child vaccination isnt child endangerment -- not at least in legal terms (yet). or engage in an occupation involving a substantial risk of danger to the childs life or health. Non-vaccination renders the child to a higher risk of health-related problems -- but its not ``abuse in legal terms.

Does Colorado mandate vaccines?

If you decide not to vaccinate your adolescent, they will be more likely to catch a range of infectious diseases that can be serious. You may also face limitations when it comes to access to school, travel options and employment opportunities.

How do I write a vaccination exemption letter?

Please initial next to each of the statements below: I request a reasonable accommodation due to my sincere religious beliefs. I understand and assume the risks of non-vaccination. I accept full responsibility for my health, thus removing liability from the City to the required vaccinations.

Who can fill out the Colorado certificate of immunization form?

Parents/guardians, emancipated students, or students 18 years or older have the option of obtaining a nonmedical exemption without a providers signature by completing the Online Immunization Education Module.

What would be a medical exemption for vaccines?

Parents can ask for a medical exemption if a vaccine wouldnt be safe for their child. Reasons that children can get an exemption include: They have a disease or take medicine that weakens their immune system. They have a severe allergy to a vaccine or an ingredient in it.

Can I refuse to vaccinate my child in Colorado?

No parent is required to vaccinate their child if they are opposed. Parents can remove their childs information from the Colorado Immunization Information System (CIIS). Immunization and/or exemption information remains confidential and private.

Is it illegal to not vaccinate your child in Colorado?

The act adds language to Colorados childrens code to clarify that refusing an immunization on the grounds of medical, religious, or personal belief considerations or opting to exclude immunization notification information from the immunization tracking system does not alone constitute child abuse or neglect.