Toxic Home Transformation Summit

Toxic Home Transformation Summit

Wednesday, August 16, 2017

Vaccine Exemptions Forms for Alaska, Hawaii, Iowa, Connecticut & Puerto Rico

Some more forms.  Grabbing as many as possible.  Download ALL of them before they disappear, and share with family, friends and people you know in those states.

Leave no stone unturned.  GET ALL THE FORMS! And SHARE them!

Leave no stone unturned.


[PDF] State of Alaska Religious Exemption Form

[PDF] Medical Exemption/Immunity Form - State of Alaska

[PDF] AK Immunization Medical Exemption Form - Sitka School District

[PDF] AK Immunization Religious Exemption Form - Sitka School District


Medical Exemption Form for medical exemptions and a Religious Exemption Form that must be notarized.

Effective July 1, 2013
Religious Exemption Documentation Requirements


State of Hawaii Vaccine Exemption
Pursuant to:
Hawaii Administrative Rules §11-157-5
Hawaii Revised Statues §302A-1156, §302A-1157, §325-0034

Hawaii State Vaccine Exemption Form  – Download Link

Alaska and Hawaii both have mandated TB Testing with no exemptions in place. However, there is someone in AK that can help with getting out of the TB testing...

For vaccination and TB tine testing exemption info. and support:

Hoss LeFevere
Egegik, Alaska 99579
(907) 233-2238


Immunization - Forms and Downloads - Iowa Department of Public Health. › Bureau of Immunization & TB › Immunization Program:

Certificate of Immunization Exemption-Medical PDF

Certificate of Immunization Exemption-Religious PDF

The Iowa Department of Public Health Immunization Program offers free print products to ... This certificate is the official Certificate of Immunization Exemption for ...
[PDF] Iowa Department of Public Health

[PDF] Iowa Department of Public Health Exemption Form.

[PDF ]Iowa Department of Public Health - Iowa Child Care Resource & Referral - Medical Exemption

Davenport Schools (Scanned Copy) PDF:
* The first originals (pdf's) are better for printing.


Immunizations Exemptions Certification Forms

Immunization exemptions are permitted under certain circumstances.  According to state law a child can be exempted from receiving a vaccine for medical conditions which are contraindicated or for religious reasons.  If one of these circumstances is true for your child please read the appropriate form below for additional information. Should you need to use an exemption form, please print the form below, complete it, and return it to your school nurse or daycare operator.

If you are using one of the translated forms, please also print the English version.

Medical Exemption Form English April, 2011

Medical Exemption Form Spanish June 2011

Medical Exemption Form Polish June 2011

Medical Exemption Form Brazilian Portuguese June 2011

Medical Exemption Form Haitian Creole June 2011

Medical Exemption Form Traditional Chinese June 2011

Reglious Exemption Form English July 1, 2015

Connecticut Vaccine Exemption Forms (from Experimental Vaccines & Connecticut Central State University: 

Religious Exemption Form

Medical Exemption Form

Connecticut Central State University Immunization Exemption Forms:


CT Religious Exemption Form
* Older scanned form

Puerto Rico:

Yes, we found those too!

[PDF] Exención a Vacunar por Razones Médicas o Religiosas Certificación

[PDF] Exención a Vacunar - Uprm


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