Affidavit Exemption from Immunizations Texas
This form serves as an affidavit for individuals seeking an exemption from Texas immunization requirements for reasons of conscience. It must be submitted individually for each person wishing to opt out of vaccinations. The form is valid for two years once notarized and must be completed accurately.
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How do I fill this out?
To fill out this affidavit, begin by providing your full name and date of birth in the designated sections. Next, indicate which vaccines you wish to exempt yourself or your child from by checking the corresponding boxes. Finally, make sure to sign and date the affidavit before a notary public to complete the process.
How to fill out the Affidavit Exemption from Immunizations Texas?
1
Provide the individual's full name and date of birth.
2
Select the vaccines you do not wish to receive.
3
Read the Benefits and Risks of Vaccination information.
4
Sign the affidavit as the parent or legal guardian.
5
Have the affidavit notarized.
Who needs the Affidavit Exemption from Immunizations Texas?
1
Parents seeking to exempt their children from vaccinations.
2
Adults wanting to decline vaccinations for personal beliefs.
3
Individuals enrolled in educational institutions requiring immunization records.
4
Healthcare workers concerned about mandated vaccinations.
5
Religious groups advocating for vaccination exemptions.
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What are the instructions for submitting this form?
To submit the completed affidavit for exemption from immunizations, send it to your child’s school administration or healthcare provider. You can also fax it to the relevant health department if applicable. Ensure to keep a copy of the submitted affidavit for your records.
What are the important dates for this form in 2024 and 2025?
It’s important to submit your affidavit for exemption before the enrollment period for schools or before vaccination deadlines in Texas. If notarized in a given year, it remains valid for two calendar years, so timely submission is essential. Always keep track of the expiration date of your affidavit to ensure compliance.
What is the purpose of this form?
The purpose of this affidavit is to formally document an individual's request for exemption from immunity requirements based on personal beliefs. This form is especially important in educational settings where schools mandate immunizations for attendance. By providing this affidavit, individuals exercise their rights while ensuring that educational institutions are aware of their exemption status.
Tell me about this form and its components and fields line-by-line.
- 1. Individual's Full Name: The full name of the person seeking the exemption.
- 2. Date of Birth: The birth date of the individual in mm/dd/yyyy format.
- 3. Vaccines to be Exempted: A checklist where the individual indicates which vaccines they do not wish to receive.
- 4. Signature: A field for the parent or guardian's signature.
- 5. Notary Public Section: A space for notarization confirming the identity of the signer.
What happens if I fail to submit this form?
Failure to submit this form may result in an individual being required to receive vaccinations. In schools, it could lead to exclusion from attendance during outbreaks or declared emergencies. Therefore, it is critical to submit the affidavit in a timely manner.
- Exclusion from School: Students may be barred from attending school if they do not provide the affidavit.
- Health Risks: Potential health risks may arise due to lack of vaccination during disease outbreaks.
- Legal Implications: Individuals could face penalties for non-compliance with immunization laws.
How do I know when to use this form?
- 1. Mandatory Vaccination Requirements: Use this form to seek an exemption due to mandatory vaccination laws in schools.
- 2. Personal Beliefs: If you hold personal beliefs that oppose vaccinations, this form will serve your needs.
- 3. Religious Exemptions: Use this form for religious reasons that warrant an exemption from immunization.
Frequently Asked Questions
Who can use the Affidavit for Exemption?
Parents, guardians, and individuals wishing to decline vaccinations can use this form.
Is the affidavit valid for multiple people?
No, a separate affidavit must be submitted for each individual.
How long is the affidavit valid?
The affidavit is valid for two years from the date of notarization.
Do I need to notarize the form?
Yes, the form must be notarized to be considered valid.
What if I change my mind about vaccinations?
You can rescind your affidavit, but it's advisable to consult with health authorities.
Can I fill this form out online?
You can edit the PDF on PrintFriendly and fill it out digitally.
Are there any risks to not vaccinating?
Yes, there are risks associated with not vaccinating, which are outlined in the form.
How do I submit the affidavit?
You can submit it directly to your school or healthcare provider after completion.
What information do I need to complete the form?
You need to provide your full name, date of birth, and the specific vaccines you wish to exempt.
Is there a fee for notarizing the affidavit?
Yes, there may be a fee charged by the notary public for their services.
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