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The following contagious diseases can spread among non-immunized individuals in a group situation, such as a college campus.  \n1. Measles: is a serious disease characterized by rash and moderate to high fever. It can lead to  \n(Rubeola) pneumonia, serious ear infections, deafness, convulsions, inflammation of the brain  \nand even death. The severe complications develop in one out of every 1,000 cases;  \none in ten of such complicated cases will result in death.  \n2. Mumps: is an acute viral infection caused by the mumps virus. It is spread by mucus or droplets from the nose or throat of an infected person, usually when a person coughs or sneezes. It can lead to deafness, meningitis (infection of the brain and spinal cord covering), painful swelling of the testicles or ovaries, and rarely, death.  \n3. Rubella: is an infectious viral disease characterized by mild fever and rash. The major risk is to (German Measles) non-immune women who catch the disease early in pregnancy. Such women are likely  \nto have a baby with serious birth defects.  \n4. Meningococcal: is a rare but potentially life threatening bacterial infection that requires immediate  \ntreatment. The bacterium, Neisseria meningitides, is the responsible germ which can manifest in one’s body as meningitis (an inflammation of the thin lining of the brain and spinal cord), septicemia (blood poisoning) as well as arthritis and pneumonia.  \n5. Hepatitis B: is an infection of the liver caused by the Hepatitis B virus. Generally, the highest  \nrisk of Hepatitis B infection is associated with occupations, lifestyles, or environments in which there is frequent contact with blood products from infected persons. Hepatitis B often is spread by contaminated needles and sexual contact. Some persons who are  \ninfected with Hepatitis B become chronic carriers, which means that the Hepatitis B  \nvirus is in their blood for more than 6 months and they may spread the infection to  \nothers for a long period of time.  \nNote: Hepatitis B became a NJ State requirement September 2008.  \nI have read and understand the above risks of non-immunization and have had the opportunity to discuss this with a medical provider. I am requesting a Religious Exemption from the above immunizations due to my religious beliefs. I will submit a written signed statement explaining how the administration of immunizing  \nagents conflicts with my religious beliefs.  \nIn consideration for that exemption, attesting that I meet the criteria as set forth in N.J.A.C. 8:57-6.11 and 8:57-6.12 for medical or religious exemption, I hereby waive any and all claims, existing now or in the future that I may have against the State of New Jersey, Stockton University, and its Board of Trustees, directors, faculty, staff, employees, officers students and agents, which may result from my failure to be immunized, knowing the risks of non-immunization, and I agree to indemnify, defend and hold harmless the State of New Jersey, Stockton University, and its Board of Trustees, directors, faculty, staff, employees, officers, students and agents, from and against any and all claims, including bodily injury and /or wrongful death suits, or other losses, damages, expenses, penalties, costs or other liabilities, including without limitation, attorneys’ fees and disbursements, arising out of, and /or resulting directly or indirectly from any claims or causes of action, including bodily injury and/or wrongful death suit brought against the State of New Jersey, Stockton University, and its Board of Trustees, directors, facul","cbCaidKGFUoPQrFW","https://ap.wps.com/l/cbCaidKGFUoPQrFW","pdf",258897,"English","# Request for Medical or Religious Exemption\n## Vaccination Requirements Covered\n## Risks of Non-Immunization\n## Applicant Attestation, Waiver, and Indemnification\n## Temporary Exclusion During Outbreaks\n## Signatures and Submission","[{\"question\":\"What vaccines does this exemption request cover?\",\"answer\":\"It requests exemption from requirements for Measles/Mumps/Rubella, Hepatitis B, and Menomune/Menactra vaccines.\"},{\"question\":\"What additional document must the applicant submit for a religious exemption?\",\"answer\":\"The applicant must submit a written signed statement explaining how administration of immunizing agents conflicts with the applicant’s religious beliefs.\"},{\"question\":\"What happens if a disease outbreak is discovered on campus?\",\"answer\":\"The institution may temporarily exclude the applicant from classes, residence halls, and sponsored activities until the outbreak is over, after consultation as specified in the form.\"}]","Request for Medical or Religious Exemption - Vaccination Requirements Form | PDF",1789522118]