VPH-28: New Jersey Certificate of Exemption from Rabies Vaccination

Enter the Name of Owner (Print), the Telephone Number, the Street Address and the City, State, Zip.

Enter the Animal Name, mark the Sex as Male or Female and Neutered as Yes or No, then enter the Species, Age, Weight, Breed and Color(s).

Enter on the line after "The animal described above has been examined by me on:" the day the animal was examined. Then the form has: "I have determined that it would be medically contraindicated to vaccinate this animal due to an infirmity, other physical condition, or regimen of therapy."

Describe the nature and duration of the infirmity, other physical condition, or regimen of therapy.

Enter the Name of Veterinarian (Print), the License Number and the Address.

The veterinarian signs on the Signature of Veterinarian line and enters the Date.

Enter the date after "This certificate is valid until"; it is not to exceed one year from the date of last examination.

By signing, the owner acknowledges that the owner is the owner of the animal described and has been informed that this animal is exempt from rabies vaccination for a period of up to one year. The animal must be re-examined by the expiration date listed. At that time the animal must either be vaccinated against rabies or, if exemption status still applies, a new certificate must be issued. Once the duration of immunity from the last rabies vaccination has lapsed, this animal is not protected against rabies and, as a result, is at increased risk of becoming infected if exposed to a rabid animal. It is recommended that the animal be closely observed when outside, walked on a leash and not allowed to run at large. Prevent the animal from coming into contact with suspect rabid animals such as raccoons, skunks, foxes, groundhogs, bats and free-roaming cats. Exemption from rabies vaccination does not exempt the animal from other laws related to rabies. If this animal is potentially exposed to rabies (e.g., due to a bite or exposure from a rabid or suspect rabid animal), the local health agency will require it to be quarantined. If this animal potentially exposes a person to rabies (by bite or other means), it must be confined for 10 days as approved by the local health agency where the animal resides.

The owner signs on the Signature of Owner line and enters the Date Signed.