Vaccine Exemptions for Children

A medical exemption must be written and signed by an appropriate health care provider (usually a doctor or other licensed practitioner). The provider must describe the child’s medical diagnosis and explain why each required vaccine  is contraindicated. . Most  states have official forms or processes for medical exemptions which are used at public schools. For example, Washington State requires a specific Certificate of Exemption form for medical reasons, signed by a licensed practitioner. In practice, work with your doctor to ensure the exemption letter uses precise medical language (for example, referencing CDC contraindications) so that schools and daycares will accept it.

Some physicians are reluctant to write exemption letters, either from uncertainty about legal requirements or fear of punishment by local health departments. Some states have limitations on how many medical exemptions physicians are allowed to sign or how these exemptions must be submitted and processed. For example, in California, medical exemptions must be submitted by medical providers through the California Immunization Registry (CAIR) system, and physicians may only write a certain number of exemptions per year. Other states have specific requirements about which physicians are allowed to write and sign exemptions, including limiting exemptions to in-state physicians or certain types of providers (MD or DO). Due to these limitations, it is not uncommon for parents to have difficulty finding a doctor willing to write and sign  an exemption. This is one of the biggest hurdles to any vaccine exemption. Please note, at Siri & Glimstad we do not recommend physicians. However, you may need to consult legal/medical experts who can help frame the medical justification correctly in order for the physician to sign the exemption. Detailed medical records (allergies, diagnoses, treatment history) can support the request.

• Childcare/Preschool: Most licensed childcare programs follow the same state immunization laws as K–12 schools, however, there are cases where small childcare centers are licensed through different provisions of the law that essentially exempt them from the state statute. In most cases, parents usually submit the same exemption form whether your child is in daycare or elementary school. Private daycare centers (especially private religious daycare centers) may set internal policies stricter than state law, and at times, may not offer exemptions. Legal action may not always be appropriate in these cases, but it’s important to talk to a licensed attorney to understand the legal and practical ramifications of legal action in these cases. Additionally, unlicensed home daycares are sometimes exempt from state-imposed rules.
• Summer Camps: Many overnight and day camps adopt similar vaccine requirements as schools, but private religious camps are not always legally bound by state exemption laws. A private religious camp can generally require all staff to be vaccinated, regardless of state exemptions.. If a camp does allow exemptions, they may often attempt to impose additional conditions (e.g. only accept medical exemptions or require early documentation). In any case, many camp health forms ask in advance about exemptions, and camps usually reserve the right to exclude exempt campers during a disease outbreak (usually without refund).
• Private Religious Camps: One frequently asked question is whether private religiously affiliated camps must offer religious and medical exemptions, and it’s important to note that private religious institutions are exempt from the ADA and may not admit a student who has a disability that prevents vaccination (yes—legally allowed to discriminate, at least for now). Most summer camps will offer medical exemptions, but only if the student meets the exact contraindications and precautions listed on the CDC’s website. Additionally, private religious institutions of all kinds, including summer camps, fall under the ecclesiastical abstention (church autonomy) doctrine—the bedrock of the First Amendment—which comes out of a case in Florida, Flynn v. Estevez, 221 So. 3d 1241 (Fla. 1st DCA 2017), where the court emphasized that the government may not “reject a religious tenet or re-label it as secular” to control a religious institution. In Flynn, a Catholic diocese school refused to enroll a student whose parent claimed a state-law religious exemption, and the court upheld the school’s right to enforce its own policy without civil-court interference. The court stressed that “A statute must always yield to the Constitution,” and that “civil courts may not insert themselves into the operation of the church.” Thus, if a religious organization finds that vaccine exemptions do not align with its understanding of scripture, it does not need to offer religious exemptions, and even if a state law purports to require exemptions, courts will not interfere with the inner workings and religious doctrine of private religious institutions, including summer camps.

Each state has its own process, but generally you must submit an official exemption form to the school or childcare center by the school’s deadline. The form usually requires you to attest that vaccinating your child would violate your religious or personal convictions. In many states, you must also complete a brief education module (in person or online) about vaccine risks and benefits before the exemption is granted.

Be careful: exemptions often expire on a yearly basis. Some states require annual renewals or periodic renewal of the statement of belief. Double-check whether your state wants a fresh affidavit each year or just once per school career.

No. You do not need to be a member of any specific religion or church. Generally, courts have invalidated any requirement for formal church membership in order to qualify for religious exemption. What matters is that the parent or guardian genuinely believes that vaccination violates their own religious belief system. In many cases, parents need only sign forms. When the state requires an affidavit in support, a written statement from the parent or guardian is sufficient. You simply explain (usually on the form) why your faith opposes immunization. The sincerity of the belief can sometimes be challenged by schools, but legally the burden is on the school to respect your declared faith if the state law allows it.

• Childcare/Preschool: In many states, licensed daycare and preschool programs are subject to the same immunization requirements (and exemptions) as K–12 schools. Similarly, other states apply their exemption rules uniformly to all school-entry settings. In short, if a religious exemption is valid for public school attendance, it may work in a licensed daycare as well. (Again, private or private religious childcare centers may have different policies.)
• Camps: Vaccine requirements at summer camps vary. Licensed camps (e.g. many overnight camps) often follow state immunization laws, but private camps generally enforce their own rules. Notably, private religious camps are not legally required to honor state non-medical exemptions. This means a camp may refuse to accept a religious or personal exemption even if it is legally valid in your home state. Before registering, carefully review the camp’s vaccine policy. Many camps reserve the right to exclude exempt children during outbreaks (mirroring school laws) and may not offer tuition refunds if an exempt child is sent home.

Short answer: Yes. Under the Ecclesiastical Abstention Doctrine, religious institutions have broad authority to make their own policies when it comes to religious issues, including whether or not to offer religious exemptions. Courts will not intervene in the inner workings of private religious schools, nor will they tell religious institutions how to interpret their own faith.

Long Answer: Under the Ecclesiastical Abstention (church autonomy) doctrine, religious institutions generally have broad authority to make and enforce their own policies on religious issues—including whether they will recognize vaccine-related religious exemptions—and courts typically will not step in to second-guess a religious school’s internal decisions or tell it how to interpret its own faith. A leading example is Flynn v. Estevez, 221 So. 3d 1241 (Fla. 1st DCA 2017), where a Catholic diocese school denied enrollment to a student whose parent claimed a state-law religious exemption, and the court upheld dismissal of the lawsuit rather than force the school to comply. In doing so, the court underscored that “A statute must always yield to the Constitution,” and that “civil courts may not insert themselves into the operation of the church,” especially where the dispute would require a court to referee competing religious views about what faith requires. In practical terms, if the school says its immunization policy reflects its religious mission or doctrine, that is exactly the kind of internal religious determination courts often refuse to adjudicate.