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Content Overview

The Tennessee Exemption Vaccination form is an important document for parents and guardians who wish to decline vaccinations for their children based on religious beliefs. This form is designed to comply with Tennessee law, specifically Tennessee Code Annotated §49-6-5001(b)(2), which allows for such exemptions. It requires the child’s name, as well as the name and address of the parent or legal guardian. By signing the form, the parent or guardian declares that the decision to decline vaccinations is rooted in their religious tenets and practices. This declaration is made under penalty of perjury, ensuring that the information provided is accurate and truthful. The form also includes a space for the signature of the parent or guardian and the date, making it a formal and legally recognized request. Understanding how to properly fill out this form is crucial for those seeking to navigate the vaccination requirements in Tennessee while honoring their personal beliefs.

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STATE OF TENNESSEE
DEPARTMENT OF EDUCATION
BILL HASLAM 6
th
FLOOR, ANDREW JOHNSON TOWER KEVIN HUFFMAN
GOVERNOR 710 JAMES ROBERTSON PARKWAY COMMISSIONER
NASHVILLE, TN 37243-0375
MODEL FORM
Religious Exemption from Vaccination(s)
Child’s Name ________________________________________________
Parent/Legal Guardian Name ___________________________________
Address _____________________________________________________
State _____ Zip __________
Pursuant to Tennessee Code Annotated §49-6-5001(b)(2), I am declining
vaccination(s) for my child because the vaccinations conflict with my
religious tenets and practices.
I declare under penalty of perjury that the foregoing is true and correct.
Parent/Legal Guardian Signature
_____________________________
Date ________________________
ED-5379

Form Specifications

Fact Name Details
Governing Law The form is governed by Tennessee Code Annotated §49-6-5001(b)(2).
Purpose This form allows parents or legal guardians to decline vaccinations for their children based on religious beliefs.
Signature Requirement A signature from the parent or legal guardian is required, along with the date of signing.
Child’s Information The form requires the child’s name and the parent or legal guardian’s name and address.

Tn Exemption Vaccination: Usage Guidelines

Once you have the Tn Exemption Vaccination form in hand, you will need to complete it accurately to ensure that your request is processed smoothly. Follow these steps carefully to fill out the form correctly.

  1. Gather necessary information: Collect your child's name, your name as the parent or legal guardian, and your address.
  2. Fill in the child's name: Write your child's full name in the designated space at the top of the form.
  3. Enter your name: In the next line, provide your name as the parent or legal guardian.
  4. Provide your address: Fill in your complete address, including the city, state, and zip code.
  5. State your reason: In the section regarding the reason for declining vaccinations, clearly indicate that the vaccinations conflict with your religious beliefs.
  6. Sign the form: At the bottom, sign your name as the parent or legal guardian to affirm the accuracy of the information provided.
  7. Date the form: Write the date next to your signature to complete the form.

After filling out the form, make sure to review it for any errors before submitting it to the appropriate school or educational institution. It's important to keep a copy for your records as well.

Your Questions, Answered

What is the Tn Exemption Vaccination form?

The Tn Exemption Vaccination form is a document provided by the State of Tennessee that allows parents or legal guardians to formally decline vaccinations for their children based on religious beliefs. This form is a way for families to assert their rights under Tennessee law, specifically Tennessee Code Annotated §49-6-5001(b)(2), which acknowledges the right to refuse vaccinations for religious reasons.

Who can fill out the Tn Exemption Vaccination form?

Only a parent or legal guardian of a child can complete this form. It requires the name of the child, as well as the name and signature of the parent or guardian. This ensures that the request is made by someone who has legal authority over the child, thereby protecting the rights of both the child and the family.

What information is required on the form?

The form requires several key pieces of information. This includes the child's name, the parent or legal guardian's name, and their address, including the state and zip code. Additionally, the form includes a declaration where the parent or guardian must state that the decision to decline vaccinations is based on religious beliefs. Finally, the parent or guardian must sign and date the form, affirming that the information provided is true and correct.

What are the consequences of submitting the form?

Submitting the Tn Exemption Vaccination form allows a child to be exempt from certain vaccination requirements in Tennessee schools. However, it is important to understand that this exemption may not apply in all situations, especially during public health emergencies when vaccination requirements could be temporarily enforced. Families should stay informed about any changes in laws or policies that might affect their exemption status.

How does one submit the Tn Exemption Vaccination form?

The completed form should be submitted to the child's school. It is advisable to keep a copy of the submitted form for personal records. Schools may have specific procedures for handling exemption requests, so checking with the school administration for any additional requirements or steps is a good practice.

Can the form be denied or challenged?

While parents and guardians have the right to submit the Tn Exemption Vaccination form, schools may review the submitted information to ensure compliance with state laws. If there are concerns about the validity of the exemption, the school may request further documentation or clarification. Ultimately, if a challenge arises, it could lead to discussions about the legitimacy of the exemption based on the specific circumstances involved.

What should I do if I change my mind after submitting the form?

If a parent or guardian decides to withdraw the exemption after submitting the Tn Exemption Vaccination form, they should notify the school as soon as possible. This may involve submitting a new form or simply informing the school of the change in decision. Keeping open lines of communication with school officials is essential to ensure that the child's vaccination status is accurately reflected and any necessary vaccinations can be arranged.

Common mistakes

  1. Failing to provide the child’s name accurately. This can lead to confusion and may result in the form being rejected.

  2. Not including the parent or legal guardian's name. This section is crucial for identifying the individual responsible for the exemption request.

  3. Leaving the address section incomplete. A full address is necessary for communication purposes.

  4. Omitting the state and zip code. These details are essential for processing the form correctly.

  5. Not clearly stating the reason for the exemption. It is important to specify that the decision is based on religious beliefs.

  6. Failing to sign the form. Without a signature, the form is considered invalid.

  7. Not dating the form. The date is important for tracking the timeliness of the exemption request.

  8. Using incorrect or outdated information regarding Tennessee Code Annotated §49-6-5001(b)(2). Ensure that the legal reference is accurate and current.

  9. Submitting the form without checking for errors. Typos or incorrect information can delay the process.

  10. Not keeping a copy of the completed form. It is advisable to retain a copy for personal records and future reference.

Documents used along the form

When navigating the process of obtaining a vaccination exemption in Tennessee, several other forms and documents may be required alongside the Tn Exemption Vaccination form. Understanding these documents can help streamline your experience and ensure compliance with state regulations. Below is a list of commonly used forms that you may encounter.

  • Certificate of Immunization: This document provides proof of the vaccinations your child has received. It may be needed to show compliance with school requirements or to clarify which vaccinations are being exempted.
  • Religious Affidavit: A detailed statement outlining the religious beliefs that justify the vaccination exemption. This document may need to be notarized to validate the claims made regarding religious tenets.
  • Medical Exemption Form: If applicable, this form is used to request an exemption based on medical reasons. A healthcare provider must sign this document to confirm that vaccinations would pose a risk to the child's health.
  • School Enrollment Form: Required for enrolling your child in school, this form may ask about vaccination status and exemptions. It ensures that the school has accurate records for all students.
  • Consent for Treatment Form: This document gives permission for medical treatment and may be necessary if your child needs medical attention while enrolled in school.
  • Emergency Contact Form: This form provides essential contact information in case of emergencies. It is crucial for schools to have this information readily available.
  • Health History Form: Schools often require a health history form that outlines your child's medical background. This can include allergies, chronic conditions, and previous vaccinations.
  • Parent Handbook Acknowledgment: Many schools provide a handbook outlining policies and procedures, including those related to vaccinations. Signing this acknowledgment confirms that you have received and understood the handbook.

Being prepared with these documents can facilitate a smoother process when applying for vaccination exemptions. Ensure that you have all necessary paperwork ready and consult with your child’s school if you have any questions or need further clarification. Prompt action can help avoid potential issues down the line.

Similar forms

The Tennessee Exemption Vaccination form serves a specific purpose in allowing parents to decline vaccinations for their children based on religious beliefs. Several other documents share similarities in function, purpose, or legal standing. Here’s a look at eight such documents:

  • Medical Exemption Form: Like the Tennessee Exemption Vaccination form, this document allows parents to opt out of vaccinations. However, it is based on medical reasons rather than religious beliefs, requiring a healthcare provider's signature.
  • Philosophical Exemption Form: This form permits parents to decline vaccinations for personal or philosophical reasons. Similar to the TN form, it requires a declaration but does not necessitate a specific religious basis.
  • Immunization Records: While not an exemption form, these records document a child’s vaccination history. They are often required to verify compliance with state vaccination laws, similar to how the TN form verifies a claim for exemption.
  • Consent Form for Vaccination: This document is used to give permission for a child to receive vaccinations. It contrasts with the TN form but serves a similar function of addressing vaccination status.
  • School Enrollment Forms: These forms often require proof of vaccination or exemption. They share a common goal with the TN form: ensuring compliance with state education and health regulations.
  • Religious Affidavit: A broader document, this affidavit can support claims of religious beliefs affecting various aspects of life, including vaccinations. It parallels the TN form in requiring a declaration of faith-based beliefs.
  • Power of Attorney for Healthcare: This legal document allows an individual to make healthcare decisions on behalf of another. It may include vaccination decisions, similar to how the TN form empowers parents to make choices for their children.
  • Waiver of Liability: This form is often used in contexts where vaccinations are administered. It releases the provider from liability and, like the TN form, addresses concerns about health decisions.

Understanding these documents can help navigate the complexities of vaccination policies and exemptions. Each serves a distinct purpose but shares the common goal of ensuring informed decisions regarding health and education.

Dos and Don'ts

When filling out the TN Exemption Vaccination form, it is important to follow certain guidelines to ensure accuracy and compliance. Below are seven do's and don'ts to keep in mind.

  • Do provide your child's full name clearly.
  • Do ensure the parent or legal guardian's name is accurate and matches official documents.
  • Do fill in the address completely, including the state and zip code.
  • Do clearly state the reason for the exemption, citing your religious beliefs.
  • Don't leave any sections of the form blank; incomplete forms may be rejected.
  • Don't use abbreviations or informal language; clarity is essential.
  • Don't forget to sign and date the form; an unsigned form is invalid.

Misconceptions

Here are six misconceptions about the Tennessee Exemption Vaccination form:

  • The form is only for religious exemptions. Many believe that the form is exclusively for religious reasons, but it can also accommodate medical exemptions.
  • Parents must provide detailed religious beliefs. Some think they need to explain their religious tenets in detail. In reality, a simple declaration is sufficient.
  • Submitting the form guarantees exemption. Some individuals assume that submitting the form automatically grants exemption. Approval may still depend on school policies.
  • The form must be notarized. Many believe that the form requires notarization. However, it only needs the parent or guardian's signature.
  • Exemptions are permanent. Some think that once an exemption is granted, it lasts forever. Exemptions may need to be renewed or verified periodically.
  • All schools accept the form without question. There is a misconception that all schools will accept this form. Policies may vary by school district.

Key takeaways

Here are some key takeaways regarding the Tn Exemption Vaccination form:

  • The form is officially provided by the Tennessee Department of Education.
  • It allows parents or legal guardians to decline vaccinations for their children based on religious beliefs.
  • Filling out the form requires the child's name and the parent's or guardian's name.
  • Address details must be included, including the state and zip code.
  • It is important to reference Tennessee Code Annotated §49-6-5001(b)(2) when stating the reason for the exemption.
  • The form includes a declaration that the information provided is true and correct, which is made under penalty of perjury.
  • A signature from the parent or legal guardian is required, along with the date of signing.
  • Ensure that the form is submitted to the appropriate educational institution in a timely manner.
  • Keep a copy of the completed form for your records, as it may be needed for future reference.