Tn Exemption Vaccination – Fill Out and Use This PDF

Updated: Nov 11, 2026

The Tennessee Exemption Vaccination form, officially known as the Religious Exemption from Vaccination(s) form, enables parents or legal guardians to declare that vaccinating their child conflicts with their religious beliefs and practices, as permitted under Tennessee Code Annotated §49-6-5001(b)(2). This declaration must be made under penalty of perjury, affirming the sincerity of the religious conviction against vaccination. To ensure the health and educational rights of your child align with your religious beliefs, consider filling out the necessary form by clicking the button below.

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Tn Exemption Vaccination PDF Details

In Tennessee, the topic of vaccination can evoke a range of responses due to personal, religious, and philosophical beliefs. To accommodate such diversity, the State of Tennessee Department of Education provides a form known as the "Religious Exemption from Vaccination(s)" document. It serves as a crucial tool for parents or legal guardians who, due to their religious convictions, decide against vaccinating their children. This form, identified under the Tennessee Code Annotated §49-6-5001(b)(2), requires the parent or legal guardian to fill out their name, along with their child's name and address, and to assert that vaccinating their child contradicts their religious beliefs. By signing the form, the individual solemnly affirms, under penalty of perjury, the truthfulness of their claim. This exemption form underscores the balance Tennessee seeks to maintain between public health policies aimed at widespread immunization and the respect for individual religious beliefs. Moreover, the simplicity of the process reflects an effort to make such exemptions accessible to those who genuinely need them, thus highlighting the state’s recognition of personal freedoms alongside its commitment to health and safety.

Question	Answer
Form Name	Tn Exemption Vaccination
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	tennessee form exemption vaccination, tennessee vaccination exemption, immunization exemption form tennessee, form religious exemption vaccination

How to Fill Out Form ED-5379

Form ED-5379 at a glance

What it is: ED-5379 is the Tennessee Department of Education Model Form, Religious Exemption from Vaccination(s).

Who signs: Write the Parent/Legal Guardian Signature.

A filled-in Form ED-5379 example: a parent declines vaccination for a child

Form ED-5379 example filled out, example: a parent declines vaccination for a child — Jane Sample, a parent in Tennessee, fills out the model form ED-5379 for her child. The picture shows a signed form with the parent's name, address and date. Every value in it is made up.

How to fill out Form ED-5379, box by box

Child's Name, Parent/Legal Guardian Name, Address, State and Zip

Write the Child's Name.

Write the Parent/Legal Guardian Name, the Address, the State and the Zip.

Parent/Legal Guardian Signature and Date

Write the Parent/Legal Guardian Signature and the Date; the parent declares under penalty of perjury that the form is true and correct.

More rules for Form ED-5379

Pursuant to Tennessee Code Annotated §49-6-5001(b)(2), the parent is declining vaccination(s) for the child because the vaccinations conflict with the parent's religious tenets and practices.

State of Tennessee Department of Education, 6th Floor, Andrew Johnson Tower, 710 James Robertson Parkway, Nashville, TN 37243-0375.

Sources

[1] Form ED-5379, Model Form Religious Exemption from Vaccination(s), Tennessee Department of Education (the Official source link on this page).