A medical exemption is permitted when a child has a medical condition that prevents them from receiving a vaccine. Medical exemptions must be renewed yearly and signed by a health care provider licensed to practice in NYS.

Religious exemptions are no longer granted in NYS.

To be completed by parent or guardian. Please list your all of your child's health conditions and current medications. If your child has severe allergies and/or anaphylaxis, please contact the school nurse prior to your child's first day of school attendance.

For completion by your child's dentist. Currently, this form is optional in New York State.