Minnesota Statutes Section 121A.15 requires children enrolled in a Minnesota school to be immunized against certain diseases, allowing for specified exemptions. Students who are not in compliance will not be allowed to start school until proof of vaccination or documentation of legal exemption is received by the district.
This form is the official document for recording legal exemptions to immunizations. Please click the upper right corner of the form to download or request a paper copy from Nurse Cassie.
*Please note- be sure to put an X next to each vaccine you are exempting your child from. Medical exemptions must be signed by a Licensed Healthcare Practitioner. Non-medical exemptions must be signed by the parents or guardian and notarized. Please do not write "all vaccines" in the exemption box. Exemption forms that do not meet the above mentioned requirements will not be accepted.
MN Immunization Exemption Form (Early Childhood)
MN Immunization Exemption Form (K-12)