Ramah Vaccination Policy Exemption Form

CAMP RAMAH IN WISCONSIN & RAMAH DAY CAMP - SUMMER 2023

VACCINATION POLICY EXEMPTION FORM

This form should be completed by a Camp Ramah in Wisconsin/Ramah Day Camp in Chicagoland parent/guardian or staff member seeking a COVID-19 vaccination exemption.

Please review the Camp Ramah in Wisconsin & Ramah Day Camp in Chicagoland Vaccination policy before completing this form.

Camp(s)*

Your Name*

First NameLast Name

Your Email*

example@example.com

Your Phone Number*

Name of Camper(s)*

EXEMPTION REQUEST

Please select the type of vaccination you are seeking exemption for?*

COVID-19 Bivalent BoosterCOVID-19 Vaccination

Please provide description of why you are requesting exemption:*

Camp Ramah makes determinations about requested accommodations and exemptions on a case-by-case basis. Camp Ramah reserves the right to request additional documentation supporting the need for an accommodation or request for any other exemption. We will keep confidential any medical information obtained in connection with your request for a reasonable accommodation or other exemption.