Immunization Exemption Form Pdf Minnesota. $100 under minnesota law for each transaction for which the certificate is used.) signature of authorized purchaser print name here title date. The parent/guardian or student over 18 years of age must sign the form in front of the notary.
Immunization exemption form
A doctor of medicine (md), doctor of osteopathy (do), physician assistant (pa), or nurse practitioner (np, dnp or aprn). To receive a vaccination exemption form, the legally responsible individual who claims the exemption for the student must complete the online immunization education module. The parent/guardian or student over 18 years of age must sign the form in front of the notary. Exemptions can be obtained by utilizing the appropriate sample immunization record forms for students, child care,. Web i, the undersigned, swear or affirm that immunization against measles, mumps and rubella is contrary to my religious tenets and practices. I understand that lost records are not grounds for an exemption. Web a list of places in minnesota where exemption forms can be notarized. Transfer student from another minnesota institution: Web minnesota law requires children enrolled in child care to be immunized against certain diseases or file a legal medical or conscientious exemption. Web this form must be completed by one of the following licensed healthcare providers:
135a.14) requires that all students born after 1956 are vaccinated against diphtheria, tetanus, measles, mumps, and rubella, allowing for certain specified exemptions (see below). Web a list of places in minnesota where exemption forms can be notarized. Office of the minnesota secretary of state notary search. Recent minnesota high school graduate exemption: The parent/guardian or student over 18 years of age must sign the form in front of the notary. I understand that lost records are not grounds for an exemption. Web form st3, certificate of exemption purchaser: 135a.14) requires proof that all students born after 1956 are vaccinated against diphtheria, tetanus, measles, mumps, and rubella, allowing for certain specified exemptions (see below). Transfer student from another minnesota institution: $100 under minnesota law for each transaction for which the certificate is used.) signature of authorized purchaser print name here title date. By my signature below, i confirm that this
