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      • Exemption Forms & Letter Template
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Exemption Forms & Letter Template

4/1/2019

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**PLEASE NOTE** Significant changes were added into the new Religious Waivers released in May 2018 that now includes the following statement implying liability of death & injury for parents with Religious Convictions.
“Exempting my child from any or all required vaccine(s) may result in serious illness, disability, or death to my child or others. I understand the risks and possible outcomes of my decision to exempt my child.“

While we cannot advise you on what to do, please proceed with caution, it is a legally acceptable alternative to write a letter requesting religious waiver approval, as some are not comfortable with the legal implications of the new wording on the  current forms. You need one form/letter for each child. 
*Forms Updated as of Jan 2019
Religious Exemption Form: https://health.wyo.gov/wp-content/uploads/2019/01/Religious-Waiver-Request-ENGL-1.2019.pdf
Medical Exemption Form: https://health.wyo.gov/wp-content/uploads/2019/01/Religious-Waiver-Request-ENGL-1.2019.pdf
Alternative Letter Option {Religious exemption} 
Letter Template:
Updated as of Aug 2019
To Print Click "Download Arrow" on SCRIBD or click on Download file links below  
religious_exemption_template.docx
File Size: 13 kb
File Type: docx
Download File

religious_exemption_template.pdf
File Size: 25 kb
File Type: pdf
Download File

Submit Forms to
  • Your local County Health Officer, or
  • The State Health Officer at Wyoming Department of Health, 6101 Yellowstone Road, Suite 420, Cheyenne, WY 82002, Attn: Immunization Exemptions.
*You can also consider notarizing your forms or sending them certified mail
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