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Affidavit Of Religious Belief

AFFIDAVIT OF RELIGIOUS BELIEF

STATE OF DELAWARE

________________________COUNTY

1. (I) (We) (am) (are) the (parent[s]) (legal guardian[s]) of ____________________

Name of Child

2. (I) (We) hereby (swear) (affirm) that (I) (We) subscribe to a belief in a relation to

a Supreme Being involving duties superior to those arising from any human

relation.

3. (I) (We) further (swear) (affirm) that our belief is sincere and meaningful and

occupies a place in (my) (our) life parallel to that filled by the orthodox belief in

God.

4. This belief is not a political, sociological or philosophical view of a merely

personal moral code.

5. This belief causes (me) (us) to request an exemption from blood lead testing for

______________________________________

Name of Child

______________________________________ ___________________________

Signature of Parent(s) or Legal Guardian(s)

SWORN TO AND SUBSCRIBED before me, a registered Notary Public, this _________

day of _______, 2_______.

_________________________ (Seal)

Notary Public

My commission expires:

__________________________

Affidavit Of Religious Belief