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SCHOOL DISTRICT PROCEDURES
for Implementing Requests for Religious Exemption to Immunization

1. Upon request, the school nurse or principal’s designee will issue to the parent/guardian seeking a religious exemption to immunization for his or her child the Request for Religious Exemption to Immunization Form–Parent/Guardian Statement, will provide the parent/guardian with Centers for Disease Control/NYS Department of Health informational immunization materials, and also will provide guidance if requested for the form’s completion. The parent/guardian is encouraged to meet with the school nurse or principal’s designee for this purpose; however, a meeting is not required.

2. The parent/guardian will return the signed and notarized form to the school nurse or principal’s designee. The form must be signed by the parent/guardian and notarized by a notary public, or it will not be accepted for review and will be returned to the parent/guardian for completion.

3. The building principal will be responsible for the review of each request for a religious exemption to immunization. If, after review of the parental/guardian statement, questions remain about the existence of a sincerely held religious belief, Department of Health regulation [10 NYCRR, Section 66-1.3(d)] permits the principal to request supporting documents. Some examples include:

• A letter from an authorized representative of the church, temple, religious institution, etc. attended by the parent/guardian, literature from the church, temple, religious institution, etc. explaining doctrine/beliefs that prohibit immunization (Note: Parents/guardians need not necessarily be a member of an organized religion or religious institution to obtain a religious exemption);

• Other writings or sources upon which the parent/guardian relied in formulating religious beliefs that prohibit immunization;

• A copy of any parental/guardian statements to healthcare providers or school district officials in a district of prior residence explaining the religious basis for refusing immunization;

• Any documents or other information the parent/guardian may be willing to provide that reflect a sincerely held religious objection to immunization (for example: disclosure of whether parent/guardian or other children have been immunized, parent/guardian’s current position on allowing himself or herself or his or her children to receive or refuse other kinds of medical treatment.)

4. The parent/guardian may request a meeting with the principal in order to provide further information about his or her sincerely held religious beliefs.

5. The parent/guardian must be informed in writing by the building principal regarding the approval or denial of the exemption request with copies to the school nurse or principal’s designee and the school superintendent. If the request is denied, the parent/guardian notification letter must include the specific reason(s) for denial.

6. If a request for a religious exemption is denied, a parent/guardian may appeal the denial to the Commissioner of Education within thirty (30) days of the decision, pursuant to Education Law, Section 310.