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.

Alaska:


[PDF] State of Alaska Religious Exemption Form
https://www.kpbsd.k12.ak.us/WorkArea/DownloadAsset.aspx?id=9908
https://www.asdk12.org/cms/lib/AK02207157/Centricity/Domain/1216/Updated%20Forms%202018/State_Religious_Exempt%20_Form.pdf
https://uaf.edu/chc/files/State-of-Alaska-Religious-Exemption-Form.pdf

[PDF] Medical Exemption/Immunity Form - State of Alaska
https://uaf.edu/chc/files/MedicalExemption.pdf
https://www.asdk12.org/cms/lib/AK02207157/Centricity/Domain/1216/Updated%20Forms%202018/State_Medical_%20Exempt_%20Immunity_Form.pdf

[PDF] AK Immunization Medical Exemption Form - Sitka School District
https://www.sitkaschools.org/cms/lib/AK01001710/Centricity/domain/52/form/student%20health/AK%20Immunization%20Medical%20Exemption%20Form.pdf

[PDF] AK Immunization Religious Exemption Form - Sitka School District
https://www.sitkaschools.org/cms/lib/AK01001710/Centricity/domain/52/form/student%20health/AK%20Immunization%20Religious%20Exemption%20Form.pdf

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

https://www.kgbsd.org/cms/lib/AK01001769/Centricity/Domain/114/MedicalExemption.pdf

https://www.kgbsd.org/cms/lib/AK01001769/Centricity/Domain/114/Religious%20Exemption%20Form%202013-2014.pdf

Effective July 1, 2013
Religious Exemption Documentation Requirements
http://dhss.alaska.gov/dph/Epi/iz/Documents/factsheet/ReligiousExemptionSupportFactSheet.pdf


Hawaii:


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

Hawaii State Vaccine Exemption Form
http://www.anewlifehawaii.com/vaccine-exemption/
http://www.anewlifehawaii.com/docs/ANL_Vaccine_Expemtion_Form.pdf  – Download Link
http://experimentalvaccines.org/wp-content/uploads/2013/05/State-of-Hawaii-School-Vaccine-Refusal-Exemption-Form.pdf


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
anglovangelist@yahoo.com


Iowa:

Immunization - Forms and Downloads - Iowa Department of Public Health. https://idph.iowa.gov › Bureau of Immunization & TB › Immunization Program:

Certificate of Immunization Exemption-Medical PDF
https://idph.iowa.gov/Portals/1/userfiles/39/Certificate%20of%20Immunization%20Exemption%20-%20Medical%2012-21-16%20Final%20%281%29.pdf

Certificate of Immunization Exemption-Religious PDF
https://idph.iowa.gov/Portals/1/userfiles/39/Certificate%20of%20Immunization%20Exemption%20-%20Religious%20June%202015.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
http://simpson.edu/wp-content/uploads/2012/07/religious_exemption2015.pdf

[PDF] Iowa Department of Public Health Exemption Form.
https://studenthealth.uiowa.edu/assets/medical-and-religious-exemption-form.pdf

[PDF ]Iowa Department of Public Health - Iowa Child Care Resource & Referral - Medical Exemption
https://iowaccrr.org/resources/files/BGP/6%20Immunization%20Exempt.pdf

Davenport Schools (Scanned Copy) PDF:
http://www.davenportschools.org/wp-content/uploads/2012/08/Religious-Exemption.pdf
* The first originals (pdf's) are better for printing.

Connecticut:

Immunizations Exemptions Certification Forms
http://www.ct.gov/dph/cwp/view.asp?a=3136&q=388416

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
http://www.ct.gov/dph/lib/dph/infectious_diseases/medical_exemptions/med_exempt_cert_form_rev_april__2011.pdf

Medical Exemption Form Spanish June 2011
http://www.ct.gov/dph/lib/dph/infectious_diseases/medical_exemptions/med_exempt_cert_form_rev_april_2011_nwi_sp.pdf

Medical Exemption Form Polish June 2011
http://www.ct.gov/dph/lib/dph/infectious_diseases/medical_exemptions/med_exempt_cert_form_rev_april_2011_nwi_pl.pdf

Medical Exemption Form Brazilian Portuguese June 2011
http://www.ct.gov/dph/lib/dph/infectious_diseases/medical_exemptions/med_exempt_cert_form_rev_april_2011_nwi_bp_brazilian_portugese.pdf

Medical Exemption Form Haitian Creole June 2011
http://www.ct.gov/dph/lib/dph/infectious_diseases/medical_exemptions/med_exempt_cert_form_rev_april_2011_creole.pdf

Medical Exemption Form Traditional Chinese June 2011
http://www.ct.gov/dph/lib/dph/infectious_diseases/medical_exemptions/med_exempt_cert_form_rev_april_2011_nwi_chinese.pdf

Reglious Exemption Form English July 1, 2015
http://www.ct.gov/dph/lib/dph/infectious_diseases/immunization/laws/religious_exemption_form_july_2015.pdf


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

Religious Exemption Form
http://experimentalvaccines.org/wp-content/uploads/2013/05/Connecticut-Religious-Vaccine-Exemption-Form.pdf

Medical Exemption Form
http://experimentalvaccines.org/wp-content/uploads/2013/05/Connecticut-Medical-Vaccine-Exemption-Form.pdf

Connecticut Central State University Immunization Exemption Forms:
https://web.ccsu.edu/healthservices/files/Exemption_from_Immunization_form_2010.pdf

http://experimentalvaccines.org/wp-content/uploads/2013/05/Connecticut-Central-State-University-Immunization-Exemption-Form.pdf


[PDF] RELIGIOUS EXEMPTION CERTIFICATION FORM
http://www.sde.ct.gov/sde/lib/sde/PDF/deps/student/health/Religious_Exemption.pdf

CT Religious Exemption Form
http://www.ctvia.org/docs/Religious_Exemption.PDF
* Older scanned form


Puerto Rico:

Yes, we found those too!

[PDF] Exención a Vacunar por Razones Médicas o Religiosas Certificación
http://www.salud.gov.pr/Dept-de-Salud/Documents/Division%20de%20Inmunizacion/Exencion%20a%20Vacunar%20por%20Razones%20Medicas%20o%20Religiosas.pdf

[PDF] Exención a Vacunar - Uprm
https://www.uprm.edu/medical/SM/documentos/Exencion_a_Vacunar.pdf

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