Vaccine Waiver Form

Example of waiver form so you can legally avoid ANY vaccination.

DO NIT SIGN any form given to you by a medical doctor or medical institution, MAKE YOUR OWN form. here is why

If you are not clear why you should use the exemption and avoid vaccines, click here.

Every state has this available, it is based on a federal law, not a state law. Following is the law used in North Carolina. If you live in NC, you may copy and paste the following example into a word program and make your own form with your personal information.

If you do not live in NC, click here for legal exemption code for your state.

Your Exemption letter should look as follows:


To whom it may concern,

>name of child/person here<


Please note the following statute for the state of North Carolina. Notice that a written exemption set forth by the adult or parent guardian is all that is required to enter any school. This notice serves as a legal exemption letter under North Carolina Statute Law.

ยง 130A-157. Religious exemption.

If the bona fide religious beliefs of an adult or the parent, guardian or person in loco parentis of a child are contrary to the immunization requirements contained in this Chapter, the adult or the child shall be exempt from the requirements. Upon submission of a written statement of the bona fide religious beliefs and opposition to the immunization requirements, the person may attend the college, university, school or facility without presenting a certificate of immunization. (1957, c. 1357, s. 1; 1959, c. 177; 1965, c. 652; 1971, c. 191; 1979, c. 56, s. 1; 1983, c. 891, s. 2; 1985, c. 692, s. 2; 2002-179, s. 17.)

Parent / Guardian Signature


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