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AFFIDAVIT OF RELIGIOUS OBJECTION TO IMMUNIZATION

AFFIDAVIT OF RELIGIOUS OBJECTION TO IMMUNIZATION . _____ personally appeared before the undersigned notary public and swore or affirmed as follows: 1. I am the parent or legal guardian of _____ (name of minor child) born _____ (date of birth). 2. I understand that the Georgia Department of Public Health requires children to obtain the following vaccinations before being admitted to a child care facility or school: diphtheria; haemophilus influenzae type B. (not required on or after the fifth birthday); hepatitis A; hepatitis B; measles; meningitis; mumps; pertussis (whooping cough); pneumococcal (not required on or after the fifth birthday); poliomyelitis; rubella (German measles); tetanus; and varicella (chickenpox).

necessary to prevent the spread of dangerous diseases among the children and people of this State; that the required vaccinations are safe; that a child who does not receive these vaccinations is at risk of contracting ... event that such a disease is in epidemic stages. This ____ day of _____, 20____. _____ Parent or Legal Guardian Sworn and ...

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