Religious Immunization Exemption Certificate
This document is essential for parents seeking a religious exemption to immunizations for their children in educational institutions. It outlines the necessary steps, signatures, and important details to complete the exemption request. Parents are encouraged to follow the instructions carefully to ensure compliance with Nevada state regulations.
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How do I fill this out?
To complete the Religious Immunization Exemption Certificate, start by entering your child's school and personal information. Next, have the parent or guardian sign and date the form, acknowledging their request for exemption. Lastly, ensure that the school completes the necessary signatures for official use.

How to fill out the Religious Immunization Exemption Certificate?
1
Enter school and student information.
2
Have the parent/guardian sign and date the form.
3
Obtain school signatures for official use.
4
Submit the form to the child's school.
5
Complete this form annually as required.
Who needs the Religious Immunization Exemption Certificate?
1
Parents of school-aged children seeking religious exemptions from vaccinations.
2
Students who are 18 years or older can request their own exemptions.
3
School administrators needing documentation for exemption compliance.
4
Health officials who need to verify vaccination exemptions.
5
Legal guardians responsible for a minor's health decisions.
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Make the necessary changes and additions.
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What are the instructions for submitting this form?
To submit the Religious Immunization Exemption Certificate, take the completed form to your child's school. Ensure that all required signatures are in place before submission. You may also submit the form via email to nviz@health.nv.gov, fax it to (775) 684-5900, or follow any online submission procedures set by the school district for timely processing.
What are the important dates for this form in 2024 and 2025?
For the 2024-2025 school year, ensure to submit your Religious Immunization Exemption Certificate according to the school district's schedule. Check with your school for specific submission deadlines. Remember that timely submission is crucial for maintaining enrollment eligibility.

What is the purpose of this form?
The Religious Immunization Exemption Certificate serves as a formal request for vaccination exemption based on religious beliefs. By completing this form, parents affirm their conviction against vaccinations and provide the necessary information for school compliance. This document helps ensure that students who are exempt can still participate in educational activities while adhering to state regulations.

Tell me about this form and its components and fields line-by-line.

- 1. Name of School: The name of the school where the exemption is being requested.
- 2. Student's Name: The full name of the student for whom the exemption is requested.
- 3. Date of Birth: The student's date of birth for identification purposes.
- 4. Grade/Level: The current educational grade or level of the student.
- 5. Parent/Guardian Signature: The signature of the parent or guardian approving the exemption.
What happens if I fail to submit this form?
If the Religious Immunization Exemption Certificate is not submitted, the student may be required to follow standard vaccination protocols. During any outbreaks of vaccine-preventable diseases, unvaccinated exempt students could face exclusion from school as a precautionary measure. It's crucial to stay informed about the submission requirements to avoid any disruptions in education.
- Risk of Exclusion: Students without an exemption may be excluded during outbreaks.
- Compliance Issues: Failure to submit may result in non-compliance with state regulations.
- Vaccination Requirement: Students may need to receive required vaccinations to continue enrollment.
How do I know when to use this form?

- 1. For New Enrollments: Complete this form for new students enrolling who require an exemption.
- 2. Annual Renewals: Submit the certificate every academic year as required.
- 3. Transfer Students: Use this form when transferring schools to maintain the exemption.
Frequently Asked Questions
What is the purpose of the Religious Immunization Exemption Certificate?
This form allows parents and guardians to exempt their children from certain vaccinations on religious grounds.
How do I fill out the exemption certificate?
Enter personal details, have the guardian sign, and ensure school signatures are obtained.
Where can I submit the filled certificate?
Submit the form directly to your child's school as per their enrollment guidelines.
Can students sign the form by themselves?
Yes, if the student is 18 years or older, they can sign the certificate themselves.
What happens if I don't submit the form?
Failure to submit may result in the exclusion of your child from school during outbreaks.
Is this form required annually?
Yes, you must submit this exemption certificate every year.
Can I edit the PDF online?
Yes, you can easily edit the PDF using PrintFriendly's editing tools.
How do I share the completed PDF?
You can share your PDF via email or social media directly from PrintFriendly.
Is it necessary to submit the form for each child?
Yes, a separate form must be completed for each student needing an exemption.
What if the school refuses to accept the certificate?
Contact your local health department for guidance on resolving this issue.
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