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Boys Running in FieldA child shall be exempt from immunization if:

Medical Exemption:

To receive an exemption of immunization for medical reasons, the parent or legal guardian of the child must acquire written documentation from a licensed physician or authorized health care provider that certifies that immunization against a particular disease may be detrimental to the child's health. The exemption shall exist only for the length of time, in the opinion of the physician; such immunization would be detrimental to the child. An exemption from immunization for one disease shall not affect other required immunizations.

Religious Exemption:

Religious exemptions can be granted when a parent or legal guardian objects to immunization because of religious beliefs. The parent or legal guardian shall sign a notarized form stating that the child has not been immunized because of religious beliefs.

To be granted Religious Exceptions the following form is required to be completed and submitted to the appropriate school administrators or school health officials.

Exclusion During Outbreak of Disease:

During an outbreak of a communicable disease for which immunization is required children exempted shall not attend the school or childcare agency threatened by the communicable disease.

If you have questions about this form, please call the NH Immunization Program at (800) 852-3345, ext. 4482.

For more information about NH immunization exemptions refer to NH State Statute, Section 141C:20-c Exemptions

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New Hampshire Department of Health and Human Services
129 Pleasant Street | Concord, NH | 03301-3852

copyright 2016. State of New Hampshire