Important: Downloadable Vaccine Exemption Forms for Various States and Situations

Important: Downloadable Vaccine Exemption Forms for Various States and Situations

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

Self-Declared COVID-19 Vaccination Exemption Form

Health Professional COVID-19 Vaccination Exemption Form

Employee COVID Vaccination Exemption Form

Military Vaccination Exemption Form

Vaccine Exemption Practical Side Supporting Document

Vaccine Exemption Religious Side Supporting Document

Vaccine Exemption Religious + Practical Supporting Documents

School Vaccine Requirements and Exemptions by State

StateStatuteReligious ExemptionPhilosophical 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. § 38-501506 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 § 39-48014802 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. § 333.92089215 Yes Yes
 Minnesota Minn. Stat. Ann. § 121A-15 Yes Yes
 Mississippi Miss. Code Ann. § 41-23-37 No  No 
 Missouri Mo. Rev. Stat. § 167.181210.003 Yes No*
 Montana Mont. Code Ann. § 20-5-403405 Yes No
 Nebraska Neb. Rev. Stat. Ann. § 79-217221 Yes  No
 Nevada Nev. Rev. Stat. § 392.435, 437, 439 Yes  No 
 New Hampshire N.H. Rev. Stat. Ann. § 141-C:20-a20-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-155156157 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 § 23-8384 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, § 11211122 Yes No
 Virginia Va. Code Ann. § 22.1-271.2§ 32.1-46 Yes No
 Washington Wash. Rev. Code Ann. § 28A.210.08090 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.

Online Request Forms by State

Texas

LINK: https://co-request.dshs.texas.gov/

PDF DOWNLOAD: https://www.dshs.texas.gov/immunize/school/pdf/EF11-13140.pdf

MORE INFORMATION: https://www.texansforvaccinechoice.com/exemptions/


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