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Arkansas 2021-2022 Immunization Exemption Application ...

Arkansas 2021-2022 Immunization Exemption Application Packet for Childcare or school StudentsThe Arkansas Board of Health requires that all children attending childcare facilities and public or private schools in the State of Arkansas be immunized against vaccine-preventable diseases. The Arkansas Department of Health is authorized by Act 999 of 2003 to grant individual exemptions from the Immunization requirements. This packet contains an Application for Exemption , which you have requested, or you may complete the online Application at An Application requesting an Exemption must be submitted for each child.

2021-2022 School Year. Please Note: To avoid processing delays, be sure to complete each part. 1. Select ONE of the following reasons for your exemption request: MEDICAL RELIGIOUS PHILOSOPHICAL (Medical - You must attach a physician’s letter stating the medical reason) 2. Child’s FULL Name and Contact Information:

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