Important: Downloadable Vaccine Exemption Forms for Various States and Situations • OP News

This article will be continually updated to reflect changes in legislation and documentation.

These are downloadable and printable COVID-19 vaccine self-exemption forms that you can complete (either online or by hand) supplied by: Professionals for Medical Informed Consent and Non-Discrimination (PROMIC)

Please download whichever form is most relevant for your purposes. The forms are electronically editable as PDF documents, or they may be printed as hard copies and completed by hand.

Statement from PROMIC

“PROMIC does not take responsibility for identifying doctors or other healthcare professionals who will declare exemptions. This is because PROMIC cannot expose such health professionals that may otherwise be targeted by licensing boards. We strongly advise you approach health professionals in your locality. In the event that your doctor or health professional is not prepared to make a declaration, we recommend you self-declare, which is your legal or constitutional right in most parts of the world.”

Children Under 16 Self-Declared COVID-19 Vaccination Exemption Form

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Self-Declared COVID-19 Vaccination Exemption Form

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Health Professional COVID-19 Vaccination Exemption Form

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Employee COVID Vaccination Exemption Form

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Military Vaccination Exemption Form

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Vaccine Exemption Practical Side Supporting Document

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Vaccine Exemption Religious Side Supporting Document

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Vaccine Exemption Religious + Practical Supporting Documents

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School Vaccine Requirements and Exemptions by State

State	Statute	Religious Exemption	Philosophical Exemption
Alabama	Ala. Code § 16-30-3	Yes	No
Alaska	Ak. Stat. §14.30.125	Yes	No
Arizona	Ariz. Rev. Stat. Ann. § 15-872, 873	Yes	Yes
Arkansas	Ark. Code Ann. § 6-18-702	Yes	Yes
California	Cal. Health & Safety Code § 120325 et seq.	No	No
Colorado	Colo. Rev. Stat. § 25-4-902, 903	Yes	Yes
Connecticut	Conn. Gen. Stat. § 10-204a	No	No
Delaware	Del. Code Ann. tit. 14 § 131	Yes	No
Washington, DC	D.C. Code Ann. § 38-501, 506	Yes	No
Florida	Fla. Stat. Ann. § 1003.22	Yes	No
Georgia	Ga. Code Ann. § 20-2-771	Yes	No
Hawaii	Haw. Rev. Stat. § 302A-1154, 1156	Yes	No
Idaho	Idaho Code § 39-4801, 4802	Yes	Yes
Illinois	105 Ill. Comp. Stat. § 5/27-8.1	Yes	No
Indiana	Ind. Code Ann. § 21-40-5	Yes	No
Iowa	Iowa Code Ann. § 139A.8	Yes	No
Kansas	Kan. Stat. Ann. § 72-5209	Yes	No
Kentucky	Ky. Rev. Stat. Ann. § 214.034	Yes	No
Louisiana	La. Rev. Stat. Ann. § 17:170(A); 40:31.16	Yes	Yes
Maine	Me. Rev. Stat. Ann. tit. 20-A § 6355	No	No
Maryland	Md. Code Ann. Educ. § 7-403	Yes	No
Massachusetts	Mass. Gen Laws ch.76, § 15	Yes	No
Michigan	Mich. Comp. Laws Ann. § 333.9208, 9215	Yes	Yes
Minnesota	Minn. Stat. Ann. § 121A-15	Yes	Yes
Mississippi	Miss. Code Ann. § 41-23-37	No	No
Missouri	Mo. Rev. Stat. § 167.181, 210.003	Yes	No*
Montana	Mont. Code Ann. § 20-5-403, 405	Yes	No
Nebraska	Neb. Rev. Stat. Ann. § 79-217, 221	Yes	No
Nevada	Nev. Rev. Stat. § 392.435, 437, 439	Yes	No
New Hampshire	N.H. Rev. Stat. Ann. § 141-C:20-a, 20-c	Yes	No
New Jersey	N.J. Stat. Ann. § 26:1A-9.1	Yes	No
New Mexico	N.M. Stat. Ann. § 24-5-1, 3	Yes	No
New York	N.Y. Pub. Health Law § 2164	No	No
North Carolina	N.C. Gen. Stat. § 130A-155, 156, 157	Yes	No
North Dakota	N.D. Cent. Code § 23-07-17.1	Yes	Yes
Ohio	Ohio Rev. Code Ann. § 3313.671	Yes	Yes
Oklahoma	Okla. Stat. Ann. tit. 70, § 1210.191, 192	Yes	Yes
Oregon	Or. Rev. Stat. § 433.267	Yes	Yes
Pennsylvania	28 Pa. Code § 23-83, 84	Yes	Yes
Rhode Island	R.I. Gen. Laws § 16-38-2	Yes	No
South Carolina	S.C. Code Ann. § 44-29-180	Yes	No
South Dakota	S.D. Codified Laws § 13-28-7.1	Yes	No
Tennessee	Tenn. Code Ann. § 49-6-5001	Yes	No
Texas	Tex. Edu Code Ann. § 38.001	Yes	Yes
Utah	Utah Code Ann. § 53G-9-303	Yes	Yes
Vermont	Vt. Stat. Ann. tit. 18, § 1121, 1122	Yes	No
Virginia	Va. Code Ann. § 22.1-271.2, § 32.1-46	Yes	No
Washington	Wash. Rev. Code Ann. § 28A.210.080, 90	Yes	No
West Virginia	W. Va. Code § 16-3-4	No	No
Wisconsin	Wis. Stat. Ann. § 252.04	Yes	Yes
Wyoming	Wyo. Stat. Ann. § 21-4-309	Yes	No

Religious exemption indicates that there is a provision in the statute that allows parents to exempt their children from vaccination if it contradicts their sincere religious beliefs.

Philosophical exemption indicates that the statutory language does not restrict the exemption to purely religious or spiritual beliefs. For example, Maine allows restrictions based on “moral, philosophical or other personal beliefs,” and Minnesota allows objections based on “conscientiously held beliefs of the parent or guardian.”

*Missouri’s philosophical exemption only applies to day care centers.