Nevada: Religious Exemption From Immunization Form printable pdf download

Nevada: Religious Exemption from Immunization Form

religion - a strong belief in a supernatural power or powers that control human destiny

religion - A set of rituals, beliefs, and rules based on a specific philosophy

RE: Written Statement Claiming Religious Exemption from Vaccination

To Whom It May Concern:

Pursuant to Nevada Revised Statutes (circle the one that applies)

392.435/392.437 (Public School)

394.192/394.193 (Private School)

432A.230/432A.240 (Child Care)

422.2932 (Recipients of public assistance) I, Marvelys Lopez, respectfully submit this written statement that

my genuine and sincere religious beliefs prohibit me from vaccinating/immunizing my child from any or all

immunizations. Childs name: ________________________ born _______________.

Our religious beliefs, however, allows us to accept medical assistance for said child if an emergency arises

i.e. a playground accident.

Sincerely,

______________________________________________________________________

(Parent Signature) (Print Parent Name) (Parent Address)

NRS 392.437 Immunization of pupils: Exemption if prohibited by religious belief. A public school shall not

refuse to enroll a child as a pupil because the child has not been immunized pursuant to NRS

392.435 if the parents or guardian of the child has submitted to the board of trustees of the school district or

the governing body of a charter school in which the child has been accepted for enrollment a written

statement indicating that their religious belief prohibits immunization of such child or ward.

NRS 394.193 Immunization of pupils: Exemption if prohibited by religious belief. A private school shall not

refuse to enroll a child as a pupil because such child has not been immunized pursuant

to NRS 394.192 if the parents or guardian of such child have submitted to the governing body a written

statement indicating that their religious belief prohibits immunization of such child or ward.

NRS 432A.240 Exemption from immunization when contrary to religious belief. If the religious belief of a

child's parents or guardian prohibits the immunization of the child as required by NRS 432A.230,

a written statement of this fact signed by the parents or guardian and presented to the operator of the facility

exempts the child from the provisions of that section for purposes of admission.

NRS 422.2932 Recipients of public assistance: Immunization of dependent children.

Subsection 3. The welfare division shall waive the requirements of subsection 1 if the failure to immunize a

dependent child is because of a religious belief or medical condition and the recipient submits

to the welfare division a written statement of that fact in the manner specified in NRS 432A.240 or 432A.250

for admission to a child care facility.

Nevada: Religious Exemption From Immunization Form