Certificate Of Exemption Page 2
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1
2INSTRUCTIONS FOR COMPLETING THE
CERTIFICATE OF EXEMPTION
Oklahoma law requires that parents of all children attending School, Child Care Facilities, and Head
Start in this state submit acceptable evidence of adequate immunization. Such evidence is required
before the child is allowed to enter or attend School, Child Care or Head Start. Children with specific
medical contraindications to any or all immunizations may be allowed to attend if the medical reason
is stated and this statement is signed by a licensed physician and submitted to the School, Child Care
Facility or Head Start. Children whose parents have objections to immunizations based on religious
teachings or personal beliefs can also apply for an exemption.
Copies of immunization records and any Certificate of Exemption must be on file with the School,
Child Care Facility or Head Start and available for review.
FORM REQUIRED:
Children enrolled in School, Child Care or Head Start.
FORM NOT REQUIRED:
Children not enrolled in School, Child Care or Head Start.
•
This form must be appropriately completed and signed or it will be denied.
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This form is to be submitted by the parent, to the School, Child Care Facility or Head Start.
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The School, Child Care Facility or Head Start will submit the form to Immunization Service.
•
Forms submitted by the Parent/Guardian will not be considered.
LOST IMMUNIZATION RECORDS
Lost immunizations records are not grounds for an exemption to the Oklahoma Law. Parents who
have lost their child’s records should be referred to their local health department or family physician.
The nurse or doctor can interpret the past immunization history and provide any needed
immunizations and create a record for the parent that can be submitted to the School, Child Care
Facility or Head Start and transcribed for the student’s record.
EXCLUSION DURING A DISEASE OUTBREAK
A disease outbreak in a School, Child Care Facility or Head Start will very likely result in exposure of
children attending on the basis of an exemption. These children are very likely to be susceptible to
the diseases and therefore may have to be excluded for the duration of any outbreak for their own
health and for the health of the other children. Parents should be informed of this possibility before
signing a Certificate of Exemption.
A completed copy of the Certificate of Exemption must be mailed by the School,
Child Care Facility or Head Start to the Immunization Service to review all exemptions.
March 2016
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