Publicnotice.crypto

, applies to any child or student
attending any center-based or family child care facility, public or independent kindergarten, elementary and
secondary schools. Each year, in order to claim a religious exemption, the current school year form must be
completed, signed, and returned to the child care or school.
Children/students with an immunization exemption may be kept out of child care or school during the course
of a disease outbreak if it is determined that such children/students are at risk for getting that disease and
transmitting it to other children/students. The length of time a child/student is excluded will vary depending on
the disease and can range from several days to more than a month.
Complete the information below. Identify the row that corresponds with the grade the child or student
is enrolled and check only the vaccine(s) for which you are exempting your child.
This form may not be altered.
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