Northstar Clasical School Immunization Waiver
AFFADAVIT TO BE SIGNED BY PARENT OR GUARDIAN
Section 3313.671, part (3): A pupil who presents a written statement of his parent or guardian in which the parent or guardian objects to the immunization for good cause, including religious convictions, is not required to be immunized.
Section 3313.671 part (4): A child whose physician certifies in writing that such immunization against my disease is medically contraindicated is not required to be immunized against that disease. This section does not limit or impair the right of a board of education of a city, exempted village, or local school district to make and enforce rules to secure immunization against poliomyelitis, rubeola, rubella, diphtheria, pertussis, and tetanus of the pupils under it jurisdiction.
I understand that the immunization Law permits me to sign a waiver on my child taking the immunization.
I hereby object and request exemption of my child from the immunization requirements for school entry because these immunizations are contrary to my pesonal beliefs.