Religious exemption letter example pa Some examples of additional/supporting information may include: A letter from religious/spiritual leader, member, or person with personal knowledge from the religious organization attended by the requestor explaining the doctrine/beliefs that prohibit all immunizations and/or the COVID-19 immunization; Jan 30, 2025 · A Vaccine Exemption Form is a document that indicates to an employer that an employee is unable to be vaccinated and requires an exemption to the employer's Vaccination Policy. Sign, print, and download this PDF at PrintFriendly. Immunizations are NOT required if the student has medical, religious, or strong moral/ethical convictions against immunization. The document is a Medical Exemption Letter from a parent or legal guardian, stating their objection to certain medical procedures for their children on religious or moral grounds. Record request forms The document is a Medical Exemption Letter from a parent or legal guardian, stating their objection to certain medical procedures for their children on religious or moral grounds. ⚪ WHAT'S INCLUDED (1) PDF file Can be printed on US LETTER SIZE 8. Jul 1, 2025 · The "Legal Loophole": A Deep Dive into Sincere Religious Beliefs While a medical exemption requires a physician's statement, the religious exemption hinges on the individual's sincerely held religious beliefs. Nov 12, 2025 · This is a religious exemption letter for the FLU vaccination. When the physician determines that immunization is no longer detrimental to the health of the child, the child shall be immunized according to this Guide to Writing Religious Exemption Requests to CV-19 Vaccines: U. Apr 22, 2015 · It is important to note that no religious affiliation or discussion is required to be shared with the school district, simply state that you are opting out based on "religious beliefs". A person who has been exempted from a vaccination is considered susceptible to the disease or diseases for which the vaccination offers protection. attached evidence thereof or I have attached a letter stating that said student has a religious exemption under Section 14-1419 of Pennsylvania Statutes Annotated. Catholic and Jewish schools are not as quick to follow the law and at times refuse to accept religious exemptions. When the physician determines that immunization is no longer detrimental to the health of the child, the child shall be immunized according to this The Philadelphia School District produces its own form but in Pennsylvania a simple declaration of exerting your rights under the PA Code Title 28 Chapter 23 is sufficient. An Affidavit Declaration of Vaccination Exemption is a legal document that allows individuals to formally declare their exemption from mandatory vaccination requirements, often for religious, medical, or personal reasons. You can use pdfFiller's add-on to do this, as well as other things. These are steps which have helped others in dealing with college vaccine requirements over the years. This letter highlights the key elements necessary for such a request, including personal identification, the basis for the exemption, and a respectful tone directed towards the authorities or The Sample Religious Exemption Letter for Covid Vaccine in Allegheny serves as a formal document for individuals seeking a religious exemption from vaccination mandates due to their faith beliefs. NOTE: This is an example of a letter that can be submitted by one’s pastor as part of a request for a religious exemption to a COVID-19 vaccine mandate. It is not to be used when a In order to request a religious exception, please fill out this form. C. Aug 8, 2014 · It is important to note that no religious affiliation or discussion is required to be shared with the school district, simply state that you are opting out based on "religious beliefs". How sincere must they be and how do they prove it?. 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 strong moral or ethical conviction similar to religious belief. This letter was used by Registered Nurse Nancy McQuiston, BSN, RN, NE-BCe, to obtain a permanent religious exemption from all vaccinations at the large health system she works for. It references the legal basis for exemption under section § 23. This information 3. But what does a religious accommodation request letter look like? There are likely many ways to write such a letter. A separate form must be used for each child with a religious exemption enrolled to enter school. 13 Your school may have an immunization exemption form, or you may use this sample exemption form. In fact, current state and federal laws also provide religious exemptions if they would not cause undue hardship on the employer. Then, clearly state your objection to immunization requirements based on your religious beliefs. receive influenza vaccination to protect myself, patients, staff, and others in the healthcare facility. 3 To exercise this right, the parent, guardian or emancipated child must object in writing to the immunization on religious grounds or on the basis of a strong moral or ethical conviction similar to a religious belief. I object to the following procedures for my children on religious grounds or on the basis of a strong moral or ethical conviction similar to a religious belief. While you are free to copy this language, it is intended as a guide, inspiring you to craft your own individual statement or to share with your lawyer so they may draft a letter on your behalf. The Sample Religious Exemption Letter for School in Pennsylvania serves as a template for individuals seeking a religious exemption for school requirements based on their beliefs. How do I fill this out? Filling out this exemption letter is straightforward. EXAMPLE TEXT (b) Religious exemption. My state has this form where the parent will write out their religious reason for refusing vaccines and the physician is supposed to sign the bottom, acknowledging that he/she provided education on the vaccines. Based on my understanding of Title VII of the Civil Rights Act and the First Amendment to the United States Constitution, and other federal and state laws, I choose This form may be used in conjunction with form REV-1715, Exempt Organization Declaration of Sales Tax Exemption, when a purchase of $200 or more is made by an organization which is registered with the PA Department of Revenue as an exempt organization. Videos to discuss the common questions regarding religious exemptions and the legal boundaries. Mar 6, 2014 · 3. Be informed about the law. 4 (d)(5) I am hereby exercising my right as a parent to have my child, [ NAME ], excused from PSSA testing because of religious and philosophical beliefs. te communication is preferred for ease of record-keeping. 1 If multiple members of your party are seeking religious exemptions, each person provide their own attestation. An Ohio vaccine exemption sample letter is a template used by individuals to formally request an exemption from mandatory vaccinations in Ohio. Attachments: (1) Education objectives by subject matter, (2) Evidence of immunization or letter of medical/religious exemption, (3) Evidence of Health and Medical Services or letter of religious exemption. Feb 24, 2015 · In order to refuse administration of the PSSAs for your child, there are three steps to follow. The template allows employees to request an exemption from an employee vaccination mandate and provide corroborating information and documentation. If you are requesting an exemption from fulfilling the university required vaccines based upon religious reasons, you must provide a letter from your church, which states that it is the belief (or doctrine) of that church to recommend against medical vaccinations, and that you are an active member of the church in good standing. 45. I am aware that in the event of an outbreak or suspected case of a vaccine- Jul 23, 2017 · State School Immunization Requirements and Vaccine Exemption Laws State laws establish vaccination requirements for school children. Apr 15, 2025 · Statistics show that states where exemptions are easy to get have more unvaccinated kids than states that make the process harder. The following is a description of my religious beliefs that prevent me from receiving the COVID-19 vaccination: [include here a description of your religious beliefs in opposition to receiving the vaccine. This person may be subject to exclusion from school, group facilities or Check out our flu exemption selection for the very best in unique or custom, handmade pieces from our templates shops. State laws vary regarding non-medical exemptions, for religious or personal reasons, and are presented in both a map and table format. CODE CH. 84 Exemption from Immunization ) Medical Exemption. The religious exemption request should state in writing that a vaccine conflicts with the individual’s sincerely held religious belief. Higher Education – College students are protected by the Civil Rights Act of 1964, and may express a religious objection to a school’s vaccination policy. Key features include a fillable section for user's personal information, a direct Provides an immunization exemption letter template for homeschooling families in Pennsylvania. I am writing on behalf of who attends this church, either online, in person, or both. What are some common religious accommodations sought in the workplace? Applicants and employees may obtain exceptions to rules or policies in order to follow their religious beliefs or practices. Religious Belief Exemption: A pupil shall be exempted from mandatory immunizations based on evidence of a truly held and genuine religious objection. It will then conclude that, under strict scrutiny review, a mandatory vaccination law that denies religious exemptions would violate the First Amendment. Keep detailed Are there exceptions based on religious or moral convictions? Yes. Sample Letter to download. The medical exemption is a written statement by the physician stating that it can be detrimental to the health of the child. Understand the key elements for a clear and concise request. 6 KB ) for free. These vaccination laws often apply not only to children attending public schools, but also to those attending private, parochial, and other types of schools. Learn how to craft a compelling and personalized request. This letter allows users to articulate their religious beliefs and the reasons for their exemption respectfully. We would like to show you a description here but the site won’t allow us. Secure your exemption with our tailored letter in PDF and MS Word formats. 6 KB | PDF: 66. Mar 27, 2025 · Customize this sample form for an employee to request a religious accommodation to a mandatory vaccination policy. Sep 19, 2020 · How to get a religious exemption from the flu shot in Massachusetts; state has seen an increase in vaccine religious exemptions while a decrease in religion Published: Sep. The PA law is clear that K-12 schools (public, private, parochial) must accept any written and signed note of religious/moral, ethical objection to vaccines from parents. It has never been denied approval because of the mention of the religious rights are guaranteed in the First Amendment of the US Constitution with example of a lawsuit Fowler vs Rhode Island. This analysis will then set forth two alternate theories — lack of general applicability and hybrid rights — that require laws denying religious exemptions to undergo heightened scrutiny. Dec 13, 2021 · As more and more employers are mandating COVID-19 vaccinations as a condition of employment, some employees are seeking religious exemptions to avoid getting the jabs. We'll examine the key arguments often included in these requests, along with legal considerations and potential alternatives. We agree with the Civil Rights Act of 1964, that when a person has a firmly held religious belief that You need to research the policies of individual facilities. Religious Exemption This exemption is issued by a county health department and based on established religious beliefs or practices. to vaccines, or to the Covid shot in particular, have a legal right to their belief and expression o rutiny about the validity of one’s beliefs, and may give your employer reason to investiga Apr 23, 2025 · In addition to state vaccine exemptions, individuals can request exemptions based on religious belief against (1) local and state governments using the First Amendment, State Constitution, and State Religious Freedom Restoration Act, and (2) federal government using the First Amendment and the Federal Religious Freedom Restoration Act. Users are instructed to personalize the letter by adapting it to fit their Philadelphia’s Regulations requiring COVID-19 vaccination for indoor dining locations does not apply to unvaccinated customers with a sincerely held religious belief against vaccination which prevents them from receiving the COVID-19 vaccination (“religious exemption”). This is NOT legal advice. The form includes a structured layout with sections for personal details, a date line, and addresses for both the sender and recipient. I, , am a student/employee at the University of Pittsburgh and am seeking an exemption from the COVID-19 vaccine because of the following sincerely held religious belief: The Sample Religious Exemption Letter for Covid Vaccine in Pima is a template designed to aid individuals seeking a religious exemption from vaccination requirements for Covid-19. 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. Oct 12, 2024 · A sample religious exemption letter for the COVID vaccine is a document that an individual can use to request an exemption from receiving the COVID vaccine on the grounds of religious beliefs. This sample form was developed in connection with CAPLAW’s Vaccines and the COVID-19 Pandemic series of conversations. This letter can help parents or guardians communicate their intent to exempt their children from vaccinations due to medical, religious, or philosophical reasons. Key features A PA immunization exemption form PDF is a document that allows parents or guardians in Pennsylvania to formally request an exemption from mandatory immunizations for their children. ” Consequently, the procedure looks like Sample Letter to download. Governor Inslee’s new Covid vaccine mandate provides an exception for those with a religious exemption. For years many districts did not collect this info, but recently we have seen many districts start to ask for proof of immunizations or an exemption for homeschool students in their district. Request for religious exemption must include a detailed written statement of personal beliefs or a letter from clergy. Users can adapt the content to their specific Religious Exemption Because the COVID Vaccination Policy conflicts with my sincerely held religious beliefs and practices or membership in a church or religious body or, with my strongly held moral or ethical beliefs of what is right and wrong, I request approval to decline COVID vaccination at this time. Religious/Sincere Personal Belief Immunization Exemption Form Based on my (a) sincerely held religious belief, observance, or practice, which includes any traditionally recognized religion, or (b) beliefs, observances, or practices that I sincerely hold and that occupy a place of importance in my life, comparable to that of traditionally recognized religions, I am requesting a religious Download free printable homeschooling forms and resources from askPauline. When the physician determines that immunization is no longer detrimental to the health of the child, the child shall be immunized according to this Oct 4, 2025 · Write a respectful flu shot declination letter. 84 Exemption from immunization. A parent or guardian wishing to exempt their child from some or all vaccinations must provide a written statement indicating the religious objections to the vaccination(s). Jul 7, 2021 · The Roman Catholic Church teaches that a person may be required to refuse a medical intervention, including a vaccination, if his or her informed conscience comes to this sure judgment. These exemption notes are received by public schools frequently and without question or discussion. Pennsylvania law permits children to refuse to be immunized based on a religious exemption. An individual who disagrees with the resolution of the request may ask the Chief Human Capital Officer to reconsider that decision within 10 business days of receiving this completed form with the Deciding Official's decision. It's important to ensure that you fill it out correctly to meet state requirements. PHILOSOPHICAL / STRONG MORAL / ETHICAL CONVICTION EXEMPTION State your reason for requesting this exemption. Sep 13, 2021 · May 17, 2021 Recipient Address Re: Religious Exemption for Vaccination of [NAME OF MEMBER] To Whom it May Concern, I am a Pastor at Revival Ministries International, a Tampa, Florida based ministry. Oct 4, 2025 · Write a respectful flu shot declination letter. S. 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 Edited: October 2021 STEP 1: Parent write letter/email to the superintendent or principal their intent to opt out. Vaccine Exemption Forms are crucial forms for employers that require employees be vaccinated, and allow employees to seek exemptions to the policy based on medical, religious or other personal reasons why they are Personal/Philosophical or Religious Exemption am exempting my child from the requirement that my child be vaccinated against the following disease(s) to attend school. The letter needs to state their objection to the assessment (s) due to their religious beliefs. An Example of Courageous Pushback for Those Facing Vaccine Mandates in the Workplace [Example letter] This letter/legal notification was sent by Police Constable Adrienne Gilvesy (a member of the Toronto Police Service) to her Chief of Police in response to mandatory vaccination and mandatory COVID testing requirements. § 23. Form DH 681, Religious Exemption From Immunization, is issued if immunizations are in conflict with the religious tenets and practices of the child's parent or guardian. Exercising Your Right to a Religious Vaccine Exemption in College If you are opposed to a vaccine due to your religious beliefs, the following steps apply to you. colleges/universities and some employers are starting to require COVID-19 vaccination for enrollment/employment. Under federal law, employers have a lot of discretion in granting the requests. ** Religious Exemption. STEP 1: Parent request in writing to the building principal to review exam within two weeks of exam. A segment of our comprehensive guide to everything you need to know about how to implement an effective mandatory vaccination policy at your company and simple solutions for tracking requirements. Sep 18, 2024 · Many companies continue to struggle to accommodate employees who don't want to get vaccines because of religious objections. EXAMPLE: Dear Superintendent: Pursuant to Pennsylvania Code Title 22 Chapter 4, section 4. Receiving the COVID-19 vaccination would violate my sincerely-held religious beliefs, practices and/or observances. While the Catholic Church does not prohibit the use of any vaccine, and generally encourages the use of safe and e Feb 26, 2015 · State law allows Pennsylvania students to cite a religious exemption from testing. Get Sample letter exemption withdrawal in Pennsylvania or any other state-specific template with just a few clicks. Pennsylvania Code §23. SAMPLE LETTER: Dear Superintendent, Discover how to get a religious exemption for vaccines, including state-specific processes, required documentation, and tips for successful applications. Note that requesting reconsideration does not extend the time limits for initiating administrative, statutory, or collective bargaining claims. View the Religious Exemption Letter Guidelines for Vaccines in our collection of PDFs. Requests for philosophical exemption must include a detailed written statement of personal beliefs. ” “This goes against our religious belief and religious teaching,” the letter states without elaborating. Start by entering your name and address at the top of the letter. com to simplify your homeschooling process in Pennsylvania. The DLM vendor produces publicly released ‘testlets’, which serve as a tool for parents to view the type of content assessed on the PA DLM. All life is a gift from God in all of its stages and is sacred. We outline what employers and employees need to know about the process. 19, 2020, 6:00 a. The forms are listed alphabetically by form number in PDF and Word template format. Nov 10, 2017 · The following is only an example of a letter of assertion of a religious exemption to vaccination. m. 4 (d) (4) I am hereby exercising my right as a parent to have my child, [NAME], excused from PSSA/Keystone testing because of religious beliefs. It is a non re-writable PDF for download. Nov 16, 2021 · Here are examples of religious exemption requests for the Covid-19 vaccine. Based on your individual situation, it may be in your best interest to get an attorney. Please provide a description below of the religious belief that guides your objection to receiving the vaccination. This letter is structured to inform the relevant parties about the removal of church membership for the purpose of relocating, demonstrating the individual's intent to attend services at a new location. Below you will find examples of language pertaining to religious/conscientious belief exemptions. [I am a Christian and active in my Church. Mar 5, 2019 · Can a health care provider force all employees to get flu shots, even over an individual's religious or medical objection? Generally, the answer is no. Many religions have tenets that conflict with the use of vaccines, and these individuals may have a right to an exemption under the law. Search and download high-quality document templates from the largest library of legal forms. The state has given districts the responsibility to collect this info. Although Pennsylvania is one of only a handful of states that offers an automatic opt-out option, the only current exemption for parents in Pennsylvania is to claim “religious and philosophical objections. HSLDA members may use one of these forms, either to submit their immunization records or file religious exemption. If applicable to your beliefs, you can send a religious exemption letter. The code is valid for exemptions to Covid19 testing which, if desired, should be added to the language of your exemption statement letter. Crafted to meet specific requirements, it ensures your case is presented clearly and effectively. Religious Exemption This form must be notarized before it is submitted. This article explores the creation of such a letter, incorporating relevant Bible verses and the concept of naturally acquired immunity. I sincerely affirm that vaccination is contrary to my religious beliefs, and that my objections to vaccination are not based solely on grounds of personal philosophy or inconvenience. This is where the often-overlooked aspect comes into play. Defining "Sincerely Held" Signature of Employee Date • Under applicable federal law, an individual can seek a religious exemption regardless of whether the religious beliefs, observances, or practices are common or non-traditional, and regardless of whether they are recognized by any organized religion. Do you guys sign religious exemption forms for vaccine refusal? I’m sure most states have their own version. If you anticipate unnecessary questioning, you may want to submit the copies of the statutes outlining the exemption requirements provided with the sample religious exemption letter above and politely inform the questioning authority that you have met the requirements of the law and show them. This form is legally recognized and outlines the specific reasons for the exemption, such as medical concerns or religious beliefs. The Sample Religious Exemption Letter for School in Philadelphia serves as a model template for individuals seeking to formally request a religious exemption from vaccination or other school requirements. If they do not have a form to provide, a letter from the parent/guardian or the individual seeking an exemption can be used. Who may use the Certificate of Religious Exemption to Required Immunizations and/or Examinations Form: Parents or legal guardians who are requesting a religious exemption to immunizations or examinations must use this form for students entering kindergarten, sixth, or ninth grades. Sincerely, May 8, 2020 · PA law requires homeschooling parents to submit a record of immunization to school officials. This model letter includes essential elements such as a clear address section, a date, and a respectful greeting directed to a church pastor. 5 x 11 inch document format COVID-19 Religious Exemption Letter Cornerstone Chapel does not have an official stance on the COVID-19 vaccines, but we support the right of Christians with religious objections to seek an exemption. May 14, 2025 · Understanding Immunization Exemption Letters What Is an Immunization Exemption Letter? An immunization exemption letter is a formal document submitted to schools, daycares, or workplaces to request an exemption from mandatory vaccination requirements. Download or preview 1 pages of PDF version of Immunization Exemption Letter Sample (DOC: 89. My Christian faith teaches that life begins at the moment of conception. Aug 18, 2025 · Learn how to effectively craft and submit a religious exemption letter. The Department of Commerce may ask for other information as needed to determine if you are legally entitled to an exception. After viewing the assessment (s) a parent or guardian determines their religious beliefs conflict with the exams, they may opt their child out of the assessment by writing a letter to the Superintendent. Apr 5, 2024 · Explore sample religious exemption letters for COVID-19 vaccine mandates. This document is an immunization exemption letter for Pennsylvania, asserting a religious objection to vaccination requirements as outlined by state law. have laws requiring certain vaccines for students to attend school. sample vaccine exemption letter pennsylvania and other documents can be changed, filled out, and signed right in your Gmail inbox. The testlet examples can be accessed as follows: Immunizations PA Code allows districts to ask for proof of/exemption of immunization. We agree with the Civil Rights Act of 1964, that when a person has a firmly held religious belief that 4 days ago · Organizations provide their own religious exemption request forms. Sep 28, 2021 · With COVID-19 vaccine mandates taking effect around the country, requests for religious exemptions are on the rise. These letters are legally recognized in certain circumstances, allowing individuals to opt out of immunizations based on medical, religious, or Navigating the process of writing a religious exemption letter can be daunting, especially when it's for something as significant as a COVID-19 vaccine. Remember that employers may grant these accommodations for religious reasons but still refuse to grant them for secular reasons. Children need not be immunized if a physician or the physician's designee provides a written statement that immunization may be detrimental to the health of the child. (Select an exemption type and the vaccinations you wish to exempt your child from): Jul 24, 2025 · All 50 states and Washington D. Learn how to write religious exemption letter using my sample. What goes into a religious exemption form for vaccination? Our attorneys for Michigan and Florida healthcare providers have your answers. But employers should review their rights and Feb 19, 2015 · The exemption shall be maintained by the school as part of the immunization record of the pupil. Nov 28, 2014 · Pursuant to Pennsylvania Code Title 22 Chapter 22 Chapter 4, section 4. Declaration for Religious Exemption from Covid-19 Vaccination To Whom It May Concern, I respectfully submit this statement of faith for a Constitutionally recognized and protected religious exemption against a mandatory injection. May 5, 2025 · Sample Religious Exemption Letter for Illinois To help you get started, here is a sample religious exemption letter specifically tailored for Illinois school immunization requirements. Instead, it The Sample Religious Exemption Letter for Covid Vaccine in Pennsylvania is a template designed for individuals seeking to formally request a religious exemption from Covid-19 vaccination requirements. What is an example of a religious exemption letter for work? I request to be exempted from the vaccine requirement on the basis of my bona fide religious belief, observance or practice. ) Religious Exemption. Those consulting this model letter should feel free to modify it to ensure it accurately reflects the sincerely-held religious beliefs of the individual requesting the exemption. Below is a DRAFT of one possible letter Dec 1, 2021 · Another letter, by a Manhattan-based Baptist pastor, says the church ministry does not support the mandate — and erroneously stated that the vaccine’s “ingredients… creates possibility of long-term adverse effects such as COVID-19. 23 on the basis of my/our religious beliefs and strong moral, ethical convictions as outlined in section § 23. Free template, steps, and rules for work or school, plus accommodation tips. Your religious/philosophical exemption letter is all you need to opt out of the schedule for school! Sep 28, 2021 · Law professor Dorit Reiss, who researches vaccine mandates and religious exemptions, shares tips for reporting on these issues amid COVID-19. View the Religious Exemption Form for Vaccinations in our collection of PDFs. These organizations are assigned an exemption number, beginning with the two digits 75 (example: 75000000). 84, which allows for both medical and religious exemptions. Many people seek religious exemptions from mandatory flu vaccinations, citing deeply held beliefs. Print, sign your name and give to your employer. Religious Exemption Sample Letters and Affidavits The following zipped file contains examples of Affidavits and letters used to submit your Religious Exemption to school or work. (b) Religious exemption. I have a sincerely held religious objection to the Covid vaccine and I am respectfully asserting my right to a religious exemption from this vaccine mandate. While medical exemptions must be supported by a letter from a medical professional, religious exemptions do not require the support or endorsement of an official clergy or recognized religious leader. 1 State laws also offer exemptions to school vaccination requirements, including medical, religious, and A religious exemption cannot be granted until after the parent/guardian(s) have reviewed the vendor released examples of testlets. SAMPLE LETTER: Dear Superintendent, Oct 19, 2021 · Please provide a personal written statement detailing your religious or sincerely held belief for requesting a vaccination exemption, and explaining why you are requesting this exemption, the principle(s) that guide your informed consent to request a vaccination exemption, and the basis that prohibits the COVID-19 vaccination. If possible, include references to religious texts or statements by 5 days ago · This religious exemption template can be used for schools/organizations for parents to fill out, businesses for employees to fill out, or for anyone who would like to provide a religious exemption from immunization requests to the appropriate parties. Using a professional template ensures that all necessary information is included. It includes options for immunizations, medical examinations, and dental examinations, along with relevant legal references. This notice serves as our objection in writing as required by Pennsylvania law. 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