Religious Exemption Certification Form - fill in and submit to the school nurse

Sep 16, 2026

Uploaded by McQueen

Religious Exemption Certification Form documents a parent or guardian’s request to exempt a student from required immunizations based on the child’s religious beliefs. The form states that the student will be permitted to attend school, except during vaccine-preventable disease outbreaks, when susceptible students may be excluded per public health officials’ determinations. Re-entry occurs only after the outbreak danger ends, the student fully recovers if ill, or the student is immunized, following NJ administrative code requirements.

LanguageEnglish

CategoryForms

FormatPDF

Pages1

AccessFree to download

Religious Exemption Certification Form

Eligibility and outbreak exclusion rule

Parent/guardian certification statement

Signatures and contact information

FAQs

Who can request a religious exemption from immunization requirements?

A parent or guardian may request an exemption for a student when immunizations would be contrary to the child’s religious beliefs.

When can the student be excluded from school despite the exemption?

The student may be excluded during vaccine-preventable disease outbreaks in the school as determined by public health officials.

What conditions allow the student to return to school?

The student may return after the outbreak danger has passed, after complete recovery from the disease, or after the student is immunized.

Sep 16, 2026

Uploaded by McQueen