Vaccine Exception Declaration for Foster Parents

Tennessee Department of Children's Services
Vaccine Exception Declaration for Foster Parents
Under T.C.A. 37-2-419, subsection b, outlined below, I request exemption from the vaccine requirements outlined in DCS Policy 16.4, Foster Home Selection and Approval.

(b) If an individual or member of the individual's household objects to an immunization on the basis of religious or moral convictions, then the exceptions in subsection (a) must not apply and the department of children's services shall not require an individual or member of the individual's household to undergo any immunization as a condition of overseeing a child in foster care.
Home Study Writer/Case Manager
Foster Parent Name Print
Foster Parent Signature

Clear
Date

MonthDayYear
Date
CS-4256, 04/24
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