Texas Department of State Health Services Page 1 of 3 Stock No. E11-13159
Immunization Branch Revised 07/2012
Frequently Asked Questions
Vaccine Exemption for Reasons of Conscience
Q. How do I obtain a vaccine exemption for reasons of conscience for my
child?
A. Parents or guardians need to request a vaccine exemption affidavit form in
writing or via a secure online request. Each child’s name and date of birth must
be included in the request. Written requests must be submitted through the U.S.
Postal Service, commercial carrier, fax, or online:
Mailing Address: Hand Deliver:
Department of State Health Services Department of State Health Services
Immunization Branch (MC 1946) Immunization Branch
P.O. Box 149347 1100 West 49th Street
Austin, TX 78714-9347 Austin, TX 78756
Fax (512) 776-7544
Secure online request form for exemption affidavit:
https://webds.dshs.state.tx.us/immco
Phone and email requests cannot be accepted.
Households requesting an affidavit for more than one child should submit only
one request form. The request should include the name and date of birth of each
child living within that household who needs affidavit forms. This will ensure you
receive the forms in a timely manner.
Q. What information will be listed on the vaccine exemption affidavit form I
receive?
A. Information on the form will include the child’s name and date of birth; a list of
required vaccines for which exemptions may be requested; a statement for the
requesting parent or guardian to indicate their relationship to the child; and an
acknowledgement that the parent or guardian has read the attached information
entitled The Benefits and Risks of Vaccinations. Parents or guardians will then
have to sign the form in front of a notary public.
Q. How many vaccine exemption affidavit forms can a parent or guardian
request at one time?
A. Parents or guardians can request up to five vaccine exemption affidavit forms per
child.
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Immunization Branch Revised 07/2012
Q. What should parents or guardians do with the vaccine exemption affidavit
form?
A. After the original vaccine exemption affidavit form is signed and notarized, it must
be submitted to the child’s school.
Q. For how long is each child’s individual exemption affidavit valid?
A. Each individual vaccine exemption affidavit is good for two years from the date
notarized.
Q. What happens if the parent or school loses the original vaccine exemption
affidavit?
A. Photocopies of the vaccine exemption affidavit form are not valid. If parents or
schools lose the exemption affidavit, the parent or guardian needs to request
another vaccine exemption affidavit in writing following the same procedures
used to obtain the first form.
Q. What if my child changes schools?
A. The vaccine exemption affidavit is part of the child’s school records and should
be sent to the new school with other school records.
Q. What will happen to the information collected on each child?
A. Requests submitted to DSHS will be returned to parents or guardians along with
the vaccine exemption affidavit forms. DSHS will track and report on the number
of affidavit requests and zip code. No other information will be maintained.
Q. Does a child have a 90-day provisional enrollment in school while awaiting
the vaccine exemption form?
A. No. Admission to a school is not allowed until records are produced showing that
(1) the child has been immunized in accordance with the rules; (2) the child has
an exemption affidavit from immunization requirements on file with the school in
accordance with the rules; or (3) the child is entitled to provisional enrollment.
Q. What is required for school enrollment if I want my child exempted from
some vaccines but not all of them?
A. Two different immunization documents will be needed: 1) an official notarized
DSHS vaccine exemption affidavit for those vaccines the parent or guardian has
chosen for reasons of conscience to have their child exempt from; and 2) a valid
immunization record indicating the month, date, and year each vaccine for which
the child is not exempt was administered, with appropriate validation by a
physician or public health clinic.
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Immunization Branch Revised 07/2012
Q. If a child currently has a religious exemption for vaccinations on file with
the school do they need to obtain a new vaccine exemption for reasons of
conscience affidavit?
A. No. Students who had religious exemptions filed at the school prior to
September 1, 2003 do not need a new vaccine exemption affidavit form. The
religious exemption on file remains valid.
Q. What if there is a vaccine-preventable disease—such as measles—
outbreak at a school?
A. Each parent or guardian who signs a vaccine exemption affidavit form also is
acknowledging they understand that their child may be excluded from school
attendance in times of emergency or epidemic declared by the Texas
Commissioner of Health.
Q. Does this new vaccine exemption option mean that my vaccinated child
may be attending school with other children who are not fully vaccinated?
A. Yes.
Q. Can an expectant parent request a vaccination exemption affidavit form for
an unborn child?
A. No. Because the child’s name and date of birth is required when the vaccine
exemption affidavit form is requested, expectant parents must wait until after the
child is born to request the vaccine exemption affidavit form.
Q. Are there other reasons a child may be exempted from vaccination
requirements?
A. A child may be exempted from one or more vaccinations for medical reasons.
The parent or guardian must provide the school with a certificate signed by a
physician (M.D. or D.O.), registered and licensed to practice medicine in the
United States, which states that, in the physician’s opinion, the immunization
required would be injurious to the child’s health and well-being or to any of the
child’s family or household members. Unless a lifelong condition is specified,
that certificate is valid for one year from the date signed by the physician and
must be renewed every year for the exclusion to remain in effect.
