Washington State Exemption Certificate for Vaccinations
This document provides a certificate of exemption for vaccinations required for school or childcare in Washington State. It includes both personal/religious and medical exemption options. Understanding how to properly fill out and submit this form is crucial for parents and guardians.
Edit, Download, and Sign the Washington State Exemption Certificate for Vaccinations
Form
eSign
Add Annotation
Share Form
How do I fill this out?
To fill out the Certificate of Exemption, start by gathering your child's vaccination records. Next, select the appropriate exemption type, whether personal, philosophical, or medical. Finally, ensure that both the parent/guardian and health care practitioner complete and sign the form.
How to fill out the Washington State Exemption Certificate for Vaccinations?
1
Gather your child's vaccination records.
2
Select the appropriate exemption type.
3
Fill in the required information accurately.
4
Have the parent/guardian sign the form.
5
Submit the completed form to your child's school or daycare.
Who needs the Washington State Exemption Certificate for Vaccinations?
1
Parents of children entering school who wish to exempt them from vaccination requirements.
2
Guardians of children in daycare who have specific religious beliefs against vaccinations.
3
Individuals seeking medical exemptions for their children due to health reasons.
4
Families who prefer personal beliefs that oppose vaccination policies.
5
Schools requiring documentation of exemptions for enrollment purposes.
How PrintFriendly Works
At PrintFriendly.com, you can edit, sign, share, and download the Washington State Exemption Certificate for Vaccinations along with hundreds of thousands of other documents. Our platform helps you seamlessly edit PDFs and other documents online. You can edit our large library of pre-existing files and upload your own documents. Managing PDFs has never been easier.
Edit your Washington State Exemption Certificate for Vaccinations online.
Editing this PDF on PrintFriendly is straightforward and user-friendly. Simply upload the document to our platform, and you'll have access to all essential editing tools. Make your changes promptly and download the updated version.
Add your legally-binding signature.
You can easily sign this PDF on PrintFriendly with our digital signing feature. After editing, just add your signature using our intuitive signing tools. Your signed document can then be downloaded immediately.
Share your form instantly.
Sharing your PDF on PrintFriendly is both easy and effective. After editing or signing, utilize our sharing options to send the document directly to others via email or social media. This ensures that your completed forms can be quickly disseminated.
How do I edit the Washington State Exemption Certificate for Vaccinations online?
Editing this PDF on PrintFriendly is straightforward and user-friendly. Simply upload the document to our platform, and you'll have access to all essential editing tools. Make your changes promptly and download the updated version.
1
Upload the PDF document to PrintFriendly.
2
Use the editing tools to make necessary changes.
3
Add any required fields or annotations.
4
Save your edited document.
5
Download or share your modified PDF as needed.
What are the instructions for submitting this form?
To submit the Certificate of Exemption, deliver the completed form directly to your child's school or child care facility. Ensure both the parent/guardian's and healthcare practitioner's signatures are present for validation. If you have questions during your submission, you may contact the facility directly or call 1-800-525-0127 for assistance.
What are the important dates for this form in 2024 and 2025?
The latest revision of this form is DOH 348-106, which must be completed following the guidelines set forth in January 2024.
What is the purpose of this form?
The purpose of the Certificate of Exemption is to allow parents and guardians in Washington State to opt out of vaccination requirements for their children based on personal, philosophical, or medical grounds. This form serves as a crucial legal document enabling families to assert their beliefs and protect their children's educational rights. It ensures compliance with state laws while safeguarding public health by acknowledging the risks of unvaccinated children during outbreaks.
Tell me about this form and its components and fields line-by-line.
- 1. Child's Last Name: The last name of the child requesting the exemption.
- 2. First Name: The first name of the child.
- 3. Middle Initial: Any middle initial of the child.
- 4. Birthdate: The date of birth of the child in MM/DD/YYYY format.
- 5. Exemption Type: Selection between personal/philosophical or medical exemption.
- 6. Parent/Guardian Declaration: Statement affirming the exemption request by the parent or guardian.
- 7. Health Care Practitioner Declaration: Certification by a licensed health care professional.
- 8. Signature Fields: Areas for required signatures by the parent/guardian and the healthcare practitioner.
What happens if I fail to submit this form?
Failure to submit the Certificate of Exemption could result in your child being unable to enroll in or attend school or daycare. Additionally, it may lead to your child being excluded during disease outbreaks. It's essential to ensure that the form is filled out correctly and submitted on time.
- Enrollment Issues: Your child may not be allowed to register for school or childcare.
- Outbreak Exclusions: Your child can be excluded from participating during vaccine-preventable disease outbreaks.
- Legal Implications: Not submitting might lead to challenges with compliance to state vaccination laws.
How do I know when to use this form?
- 1. School Enrollment: For enrolling a child who is exempt from required vaccinations.
- 2. Childcare Arrangements: When placing a child in daycare and needing vaccination exemptions.
- 3. Medical Exceptions: In cases where a healthcare provider has advised against vaccinations for medical reasons.
- 4. Religious Exemptions: For families following faith-based beliefs opposing vaccinations.
- 5. Philosophical Beliefs: When personal convictions may conflict with vaccination mandates.
Frequently Asked Questions
What is the Certificate of Exemption?
It is a document that allows parents or guardians to exempt their children from vaccination requirements for school or daycare.
Who completes this form?
The form must be completed by a parent/guardian and a licensed health care practitioner.
Can I edit the PDF before submitting?
Yes, you can edit the PDF using PrintFriendly's editing features to ensure all information is accurate.
How do I submit this form?
Once completed, submit the form directly to your child's school or childcare facility as instructed.
What if I need help filling it out?
You can refer to the instructions provided with the form or consult with your healthcare provider.
Is there a deadline for submitting this form?
It is recommended to submit this form as soon as possible to avoid any issues with school or childcare enrollment.
Can I share the PDF with others?
Yes, PrintFriendly allows you to easily share your PDF highlights via email or social media.
What should I do if my situation changes?
If your child's vaccination status changes, you will need to fill out a new form.
How can I ensure my signature is valid?
Make sure to sign the document digitally or print it out for a physical signature before submission.
What if I accidentally submit the wrong information?
If this happens, you should contact the school or daycare immediately to rectify the situation.
Related Documents - WA Exemption Cert
Preparticipation Physical Evaluation Form
The Preparticipation Physical Evaluation Form is used to assess the physical health and fitness of individuals before they participate in sports activities. It covers medical history, heart health, bone and joint health, and other relevant medical questions.
Health Insurance Tax Credits Guide 2015
This document provides a comprehensive guide on health insurance and premium tax credits for the 2015 tax year. It explains the tax filing rules, eligibility criteria, and detailed instructions for claiming and reporting premium tax credits. Essential for individuals who bought health insurance through the ACA Marketplaces.
TSP-77 Partial Withdrawal Request for Separated Employees
The TSP-77 form is used by separated employees to request a partial withdrawal from their Thrift Savings Plan account. It includes instructions for completing the form, certification, and notarization requirements. The form must be filled out completely and submitted along with necessary supporting documents.
Ray's Food Place Donation Request Form Details
This file contains the donation request form for Ray's Food Place. Complete the general information section and follow the guidelines to submit your donation request at least 30 days in advance. The form includes fields for organization details and donation specifics.
Pastoral Ministry Evaluation Form for Board of Elders
This evaluation form is designed for the Board of Elders to assess and provide feedback on a pastor's ministry. It aims to offer affirmation and identify areas for improvement. The form covers preaching, worship leading, pastoral care, administration, and more.
Health Provider Screening Form for PEEHIP Healthcare
This file contains the Health Provider Screening Form for PEEHIP public education employees and spouses. It includes instructions on how to fill out the form for wellness program participation. The form collects personal, medical, and screening details to assess wellness.
Common Law Marriage Declaration Form for FEHB Program
This form is used to declare a common law marriage for the purpose of enrolling a spouse under the Federal Employees Health Benefits (FEHB) Program. It requires personal details, marriage information, and additional documentation. Submission instructions and legal implications are included.
MyPRALUENT™ Enrollment Form Instructions and Details
This document provides comprehensive instructions and details for enrolling in the MyPRALUENT™ program, including benefits, patient assistance, and clinical support. It outlines the required patient, insurance, and prescriber information, as well as the steps for treatment verification and household income documentation.
Application for Certified Copy of Birth Certificate
This form is used to request a certified copy of a birth certificate from the Clerk of Court Office. It includes details about the applicant, the person named on the certificate, and requires a photo ID and the correct fee. This form is only for walk-in services.
Torrance Memorial Physician Network Forms for Patients 18+
This file contains important forms for patients 18 years and older registered with Torrance Memorial Physician Network. It includes patient registration, acknowledgment of receipt of privacy practices, and financial & assignment of benefits policy forms. Complete these forms to ensure your medical records are up-to-date and to understand your financial responsibilities.
Vodafone Phone Unlocking Guide: Steps to Unlock Your Phone
This guide from Vodafone provides a step-by-step process to unlock your phone. Learn how to obtain your unlock code by filling out an online form. Follow the instructions to complete the unlocking process.
Texas Automobile Club Agent Application Form
This file is the Texas Automobile Club Agent Application or Renewal form, which must be submitted within 30 days after hiring an agent. The form includes fields for agent identification, moral character information, and requires signature from both the agent and an authorized representative of the automobile club. Filing fees and submission instructions are also provided.
