Vaccine Exemption Forms for Kentucky, Tennessee, Illinois, Indiana, North Carolina, and Virginia

These forms should ALL be downloaded, saved shared, even if one is from a different state, because you never know who may end up needing them, especially if they disappear from the internet.

I will come back and add the rest of the forms for these states, as there are usually more than one, but at least want to get these links out right now.

Exemption Forms for the following states...


Kentucky:

[PDF] COMMONWEALTH OF KENTUCKY CERTIFICATE OF RELIGIOUS EXEMPTION
https://web.archive.org/web/20170701235744/http://education.ky.gov/districts/SHS/Documents/ReligiousCertificateRev082010.pdf

[PDF] CERTIFICATE OF MEDICAL EXEMPTION
https://www.jefferson.kyschools.us/file/9390

[PDF] VACCINATION EXEMPTION PURSUANT TO THE KENTUCKY REVISED STATUES (KRS) § 158.035
http://wakeupgethealthy.com/wp-content/uploads/2018/10/ky-religious-exemption-affidavit.pdf

[PDF] IMM-2 Immunization Religious Exemption Form
http://www.warrencountyschools.org/userfiles/1382/Student%20Services/Religious%20Exemption.pdf

[PDF] REQUEST FOR RELIGIOUS EXEMPTION
http://wakeupgethealthy.com/wp-content/uploads/2018/10/VACEXMPT.pdf

Kentucky - The original title of the page - Experimental Vaccines
http://experimentalvaccines.org/vaccine-exemption-forms/kentucky/


Tennessee:

[PDF] MODEL FORM Religious Exemption from Vaccination(s)
https://www.ccsk12.com/images/uploads/documents/Religious_Immun_Exemp.pdf
https://web.archive.org/web/20160221212313/http://web.knoxnews.com/pdf/120708vax-religious-exempt.pdf

[PDF] WCS Immunization Religious Exemption Affidavit - Williamson County ...
WILLIAMSON COUNTY SCHOOLS IMMUNIZATION EXEMPTION AFFIDAVIT
https://www.wcs.edu//pdf/health/Religious-Exemption-Affidavit.pdf

Mirror:  http://wakeupgethealthy.com/wp-content/uploads/2018/10/WCS-Immunization-Religious-Exemption-Affidavit.pdf
Exemption Requests Information:  https://www.wcs.edu//pdf/health/Religious-Exemption-Information.pdf


[PDF] vaccination(s) refusal due to personal religious beliefs - Knox County Schools
http://www.knoxschools.org/site/handlers/filedownload.ashx?moduleinstanceid=12500&dataid=3378&FileName=religious%20exemption%20letter.pdf

[PDF] IMMUNIZATION EXEMPTION FORM Medical Exemption Religious Exemption ...
THE UNIVERSITY OF TENNESSEE AT MARTIN STUDENT HEALTH AND COUNSELING SERVICES
https://uthsc.edu/health-services/documents/immunization-exemption-form.pdf

[PDF] Religious Exemption - UTM.edu
https://www.utm.edu/departments/shcs/_pdfs/Religious%20Exemption.pdf

Illinois:

Illinois Religious Exemption Letter - Scribd
https://www.scribd.com/document/20732332/Illinois-Religious-Exemption-Letter

[PDF] Certificate of Religious Exemption Form - IDPH
http://www.dph.illinois.gov/sites/default/files/forms/religious-exemption-form-081815-040816.pdf

http://idph.prod.acquia-sites.com/sites/default/files/forms/religious-exemption-form-081815-040816.pdf

http://www.regardingcaroline.com/exemptionletter.html

C P S Chicago Public Schools.
125 S. Clark. Chicago, Illinois 60603.
PHYSICAL EXAMINATION and/or IMMUNIZATION WAIVER FORM
http://www.nettelhorst.org/pdf/forms/OR_CPS_Physical_Exam_Immunization_Waiver.pdf
* State specific religious belief that forbids immunizations below
Grab a text from some of the VacLib archived versions below, and be sure to also cite the statute/law.

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From VacLib Illinois page (archived version):

Sample Religious Vaccination Exemption
http://www.vaccineawareness.org/information/Sample... 

Illinois Religious exemption letter.doc
http://www.vaclib.org/letters/Illinois%20Religious%20exemption%20letter.doc

IllinoisReligiousexemptionletter.doc (larger font)
http://www.vaclib.org/letters/IllinoisReligiousexemptionletter.doc

VaccineTruth.net/letters/Illinois Catholic Religious Exemption letter.doc
http://www.vaclib.org/letters/Illinois%20Catholic%20Religious%20Exemption%20letter.doc

VaccineTruth.net/letters/Illinois Catholic religious exemption for VARIVAX.doc
http://vaclib.org/letters/Illinois%20Catholic%20religious%20exemption%20for%20VARIVAX.doc

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Indiana:

NOBLESVILLE SCHOOLS
18025 River Road  •  Noblesville  •  IN 46062

[PDF] Immunization Religious Exemption .pdf - Noblesville Schools
https://www.noblesvilleschools.org/site/handlers/filedownload.ashx?moduleinstanceid=7336&dataid=2477&FileName=Immunization%20Religious%20Exemption%20.pdf

[PDF] Religious Exemption Letter - Noblesville Schools
https://www.noblesvilleschools.org/cms/lib07/IN01906676/Centricity/Domain/222/ReligiousExemptionLetter.pdf

VACCINE MEDICAL EXEMPTION for Providers
State Form 54648 (4-11)
Indiana State Department of Health, Immunization Division
http://www.doe.in.gov/sites/default/files/health/medical-exemption-form-providers.pdf

(.doc) VaccineTruth.net/letters/ExemptionVacLib-Indiana.doc.
http://vaccinetruth.net/letters/ExemptionVacLib-Indiana.doc

[DOC] religious exemption letter
https://www.ltschools.org/MediaLibraries/ltschools.org/Documents/District/Health/Religious-Exemption_2.doc
STATEMENT OF IMMUNIZATION HISTORY;. WAIVER; RULES - INDIANA CODE §20-34-4-5. (a) Each school shall require the parent of a student who has enrolled in the school to furnish not later than the first day of school a written statement of the student's immunization, accompanied by the physician's certificates or other documentation, unless a written statement of this nature is on file with the school ...

[PDF] Indiana Religious Immunization Exemption Request Form
http://experimentalvaccines.org/wp-content/uploads/2013/06/Indiana-Immunization-Religious-Exemption-Request-Form.pdf
As a parent/guardian having control of and responsibility for. , a minor enrolled in the. school, I request that said minor be exempt from the vaccination and immunization requirements on religious grounds in accordance with the Indiana Code 20-8.1-7-9.5 section 2A ...

[PDF] Indiana Religious Vaccine Exemption Form - Experimental Vaccines
http://experimentalvaccines.org/wp-content/uploads/2013/06/Indiana-Religious-Vaccine-Exemption-Form.pdf


North Carolina:

[PDF] NORTH CAROLINA IMMUNIZATION LAW RELIGIOUS EXEMPTION
http://www.langtreecharter.org/wp-content/uploads/2015/04/NC-Exemption.pdf

NORTH CAROLINA IMMUNIZATION LAW
RELIGIOUS EXEMPTION
NORTH CAROLINA GENERAL STATUTE 130A-157
[PDF] North Carolina Immunization Religious Exemption Form
https://www.cabarruscharter.org/pdf/NC-Exemption.pdf


Virginia:

[PDF] Certificate of Religious Exemption - Commonwealth of Virginia
http://www.doe.virginia.gov/support/health_medical/certificate_religious_exemption.pdf


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