The Arizona Religious Beliefs Exemption Form was created by the Arizona Department of Health Services (ADHS) to provide a lawful process for parents whose religious convictions are in conflict with the state's mandatory vaccination requirements. The form is required for enrollment in any licensed preschool, child care facility, or Head Start program in Arizona.
The exemption form covers all vaccines mandated by Arizona for young children. Parents or guardians must initial next to each vaccine they wish to decline. The vaccines listed include the DTaP combination (diphtheria, tetanus, pertussis), poliovirus (IPV), MMR (measles, mumps, rubella), Haemophilus influenzae type b (Hib), hepatitis B, hepatitis A, and varicella (chickenpox). Each initial confirms that the parent has received information about the disease and understands the health risks of not vaccinating.
By completing the form, parents acknowledge that vaccine-preventable diseases can result in serious medical complications including hospitalization, long-term disability, or death. The ADHS advocates for vaccination as the most effective protection against these illnesses, but also recognizes the right of parents with sincere religious beliefs to opt out through this documented process.
One important consequence of filing the exemption is that the child may be excluded from attending child care or preschool during an active outbreak of a vaccine-preventable disease. This exclusion policy applies to protect other children in the facility, including infants too young to be vaccinated and children with medical contraindications to vaccines. The exclusion may last several days to several weeks depending on the outbreak timeline.
After the form is completed, it must be submitted to and kept on file at the child care facility or preschool. The facility is required to include this form in the child's official enrollment records. If the child transfers to a new facility, a fresh copy of the exemption form may be required. Parents are advised to keep a personal copy as well.
Arizona provides the religious belief exemption as a recognized legal right under state law, while continuing to recommend vaccination through its public health programs. Parents who are considering an exemption are encouraged to consult with their pediatrician to review the risks before making a final decision.
| Question | Answer |
|---|---|
| Form Name | Arizona Religious Beliefs Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | arizona religious exemption, religious exemption form az, religious exemption az, religious exemption form for vaccines |