Vaccine Exemption Form
A Vaccine Exemption Form is a document used by the parents/guardian requesting their child not to receive vaccine or immunization required by the state or the country. There are a lot of reasons why parents/guardians refuse this type of medical practice. It could be based on religion, experience, or beliefs. The country or state respects their decision however, they need to fill up this exemption form and they need to agree to the terms provided in the form.
This Vaccine Exemption Form template contains form fields about the child, parent/guardian details, vaccine names, acknowledgment, waiver, and release. The vaccines are listed in a table format wherein the parent or guardian can choose if they want their child to be exempted on all or specific vaccines only. It also asks if the exemption is temporary or permanent. This form template also asks for the reason why the parent/guardian refuses vaccination. This form is using the E-signature widget to capture the digital signature of the parent/guardian, the doctor or physician, and the health care official.
These templates are suggested forms only. Before using this or any form as a contract or other legal document, please consult with an attorney to make sure it meets the legal needs or your situation. Do not use this form to send a legal request to Jotform.
These templates are suggested forms only. Before using this or any form as a contract or other legal document, please consult with an attorney to make sure it meets the legal needs or your situation. Do not use this form to send a legal request to Jotform.
