[PDF] [PDF] Minnesota Conscientious Exemption to Vaccination - Vaccine Safety

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Additional exemptions: • Children 7 years of age and older: A history of 3 doses of DTaP/DTP/DT/Td/Tdap and 3 doses of polio vaccine meets the minimum

[PDF] Minnesota Conscientious Exemption to Vaccination - Vaccine Safety

are exercising our rights under the First Amendment of the US Constitution and Minnesota Statutes: 121A 15 Health Standards; Immunizations; School Children;  

[PDF] Immunization Record Form - MN Dept of Health - Trinity School at

to your doctor or call the Minnesota Immunization Information Connection (MIIC) at this form • Document medical and/or non-medical exemptions in section 1

[PDF] Child Care Immunization Form - Minnesota Dept of Health

Minnesota law requires children enrolled in child care to be immunized against certain diseases or file a legal medical or conscientious exemption Parent/ 

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Sign or get the signatures needed for the back of this form • Document medical and/or non-medical exemptions in section 1 • Verify history of varicella disease in 

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They also pose a risk to the health of other children in your care Immunization requirements Child care and early childhood program providers must have records 

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Immunizations required for child care, early childhood programs, and school Name Birthdate Document medical and/or non-medical exemptions in section 1

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Medical exemption for Developed by the Minnesota Department of Health - Immunization Program (11/11) #140-0155 minimum requirements of the law

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I have previously met the MMR (measles, mumps, rubella) and Td (tetanus, diphtheria) requirements because I graduated from a Minnesota high school in 1997 

[PDF] Child Care Immunization Record - Minnesota Dept of - Playworks

This or another form documenting immunizations or an exemption must be kept on file with the child care provider Electronic immunization records are an 

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Minnesota Conscientious Exemption to Vaccination

Prepared by the Vaccine Safety Council of Minnesota http://vaccinesafetycouncilminnesota.org/ info@vaccinesafetycouncilminnesota.org To Whom It May Concern at __________________ School District; _____________________________, as the Parent(s) of ____________________ are exercising our rights under the First Amendment of the US Constitution and Minnesota Statutes: 121A.15 Health Standards; Immunizations; School Children; Subd. 3 (d) to file a Religious/Conscientious Exemption to all vaccinations.

Respectfully,

Parent(s) Names ____________________________

Parent(s) of ________________________________

Date__________

Notarized:

State of ___________________________, __________________________ County I, _________________________________, a Notary Public for said County and State, do hereby certify that _____________________________________________________ personally appeared before me this day and acknowledged the due execution of the foregoing instrument. Witness my hand and official seal, this the ___ day of _________, 20 ____. Notary Signature: _____________________________________________________quotesdbs_dbs10.pdfusesText_16