7:280- E4 Acknowledgement of Religious Exemption Claim

On District Letterhead

DATE

Dear Parent/Guardian of:  ________________________________

ACKNOWLEDGEMENT OF RELIGIOUS EXEMPTION CLAIM

The claim for Religious Exemption you have submitted on behalf of the above-mentioned students has been reviewed.

The following State Requirement(s) are missing from the objection you submitted:

• Statement of the religious belief that relates to immunization or physical exam
• Statement of relationship to student
• Date of the objection letter
• Specify which immunizations you are objecting to
• Restated or updated to meet the requirements for mandated grade entry for Preschool, Kindergarten, 5th grade (Hepatitis B vaccine), 6th grade and 9th grade

Please submit the information checked as soon as possible.

RELIGIOUS EXEMPTION TO MEASLES VACCINE

If you are claiming religious (or medical) exemptions for your child to the measles vaccine, please read the statement below, sign and return to your building nurse immediately.

In accordance with the Illinois Department of Public Health’s Control of Communicable Disease Code Section 690.520, the following information is being shared.  In the event of a Measles outbreak, a notice will be sent home to each student who has not presented proof of immunity.  This notice will explain that the student is to be excluded from school, effective the following morning, until acceptable proof of immunity is received by the school, or until 21 days after the onset of the last presented measles case.  This information is being shared with you, so that in the event of a measles outbreak, you will be prepared for the impact that a situation of this type will have on your child.  I understand the above and agree to adhere to the exclusion policy above.

Parent/Guardian Signature:  ______________________________

Date:  __________________

Date Adopted:  05/30/2014