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STATE OF TENNESSEE DEPARTMENT OF EDUCATION BILL HASLAM GOVERNOR 6th FLOOR ANDREW JOHNSON TOWER 710 JAMES ROBERTSON PARKWAY NASHVILLE TN 37243-0375 KEVIN HUFFMAN COMMISSIONER MODEL FORM Religious Exemption from Vaccination s Child s Name Parent/Legal Guardian Name Address State Zip Pursuant to Tennessee Code Annotated 49-6-5001 b 2 I am declining vaccination s for my child because the vaccinations conflict with my religious tenets and practices.
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How to fill out religious exemption form tn
How to fill out religious exemption form Tennessee:
01
Obtain a copy of the religious exemption form from the Tennessee Department of Health or download it from their website.
02
Fill in the necessary personal information such as your name, address, and contact details.
03
Indicate the specific religious beliefs that prohibit you or your child from receiving certain vaccinations.
04
Provide any supporting documentation or statements from your religious organization or leader that explain and reinforce your religious beliefs.
05
Sign and date the form.
06
Submit the form to the appropriate authority, which is typically the local health department or your child's school, depending on the circumstances.
Who needs religious exemption form Tennessee:
01
Individuals who have religious beliefs that conflict with vaccination requirements in Tennessee.
02
Parents or guardians who wish to exempt their child from receiving certain vaccinations based on religious beliefs.
03
Students or individuals who attend educational institutions or work in settings that require proof of vaccination but seek an exemption based on religious grounds.
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What is religious exemption form tennessee?
In Tennessee, religious exemption forms are forms that must be completed by parents or guardians of children who wish to be exempt from the state's mandated immunization requirements for school enrollment. The form must be signed by a physician or an authorized representative of the religious organization. On the form, the parent or guardian must provide information such as their child's name, date of birth, and the religious beliefs that merit an exemption from immunizations.
What is the purpose of religious exemption form tennessee?
The purpose of the Tennessee Religious Exemption Form is to provide an exemption from mandatory immunization requirements for children attending school, daycare, or any other program or activity. The form allows parents or guardians to declare a religious belief that opposes or prohibits immunizations for their children.
What information must be reported on religious exemption form tennessee?
The information that must be reported on the Religious Exemption Form (Tennessee) includes:
1. The name of the child and parent/guardian
2. The child’s date of birth
3. The name of the school the child is attending
4. The name of the church or religious organization with which the parent/guardian is associated
5. A statement of the religious belief that conflicts with immunizations
6. A statement that the parent/guardian is the legal custodian of the child
7. Signature of the parent/guardian and date of the request for exemption
Who is required to file religious exemption form tennessee?
According to Tennessee law, parents or legal guardians who wish to exempt their child from immunizations based on religious beliefs are required to file a religious exemption form. This form must be signed and notarized and submitted to the child's school or daycare facility.
What is the penalty for the late filing of religious exemption form tennessee?
According to the Tennessee Department of Health, there is no specific penalty outlined for the late filing of a religious exemption form for immunizations. It is advised to submit the form as soon as possible to comply with state regulations. However, it is recommended to contact your local health department or speak with a legal professional for the most accurate and up-to-date information regarding any penalties or consequences associated with late filing.
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