Letters can also be found by reaching our to district nursing staff and/or in school district main offices.
IMMUNIZATION EXEMPTION LETTER
Name
Address
Date:
To Whom it May Concern:
Re: Pennsylvania Religious Exemption 1/We,______________being the parents/legal guardians of object to the immunization requirements as outlined by the Department of Health of the Commonwealth of Pennsylvania as defined in 28 PA. CODE CH.23 on the basis of my/our religious beliefs and strong moral, ethical convictions as outlined in section § 23.84
Exemption from immunization. This notice serves as our objection ni writing as required by Pennsylvania law.
Sincerely,
Parent/Legal Guardian Name Signature
(a) Medical exemption. Children need not be immunized fi a physician or the physician's designee provides a written statement that immunization may be detrimental to the health of the child. When the physician determines that immunization is no longer detrimental to the health of the child, the child shall be immunized according to this subchapter.
(b) Religious exemption. Children need not be immunized if the parent, guardian, or emancipated child objects in writing to the immunization on religious grounds or on the basis of a strong moral or ethical conviction similar to a religious belief.