Religious Immunization Exemption Certificate For Use in ...
Religious Immunization Exemption Certificate For Use in Public and Private Daycare, Preschool, School & College . Instructions for completing a Religious Immunization Exemption Certificate Section 1: Enter student information. Section 2: Have parent/guardian or student (if the student is 18 years of age or older) initial, sign, and date after ...
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www.doe.virginia.govCERTIFICATE OF RELIGIOUS EXEMPTION Name _____ Birth Date _____ Student I.D. Number _____ The administration of immunizing agents conflicts with the above named student's/my religious tenets or practices. I understand, that in the occurrence of an