Nc Religious Exemption Form Pdf - If the bona fide religious beliefs of an adult or the parent, guardian or person in loco parentis of a child are contrary to the. Domestic/international health department immunization record. High school transcript or college/university record. Please submit forms to your patient portal. Program manager’s name and contact information: Phone number (enter with no dashes): Program associated with vaccine requirement: For questions or concerns, please call student health services at, 910.521.6219. Religion and tenet(s) that prohibit vaccination: Accepted forms of immunization documentation include:
High school transcript or college/university record. Shs form medical religious exemption form_2023.pdf. Accepted forms of immunization documentation include: If the bona fide religious beliefs of an adult or the parent, guardian or person in loco parentis of a child are contrary to the. For questions or concerns, please call student health services at, 910.521.6219. Religion and tenet(s) that prohibit vaccination: Domestic/international health department immunization record. Program manager’s name and contact information: Please submit forms to your patient portal. Program associated with vaccine requirement: Religious exemption if the bona fide religious beliefs of an adult or the parent, guardian, or person in loco parentis of a child are contrary to the immunization requirements contained in this part, the adult or the child shall be exempt from the requirements. Web physician’s request for medical exemption (pdf, 136 kb) (dhhs 3995) use this form for contraindications not recognized by the commission for public health. These forms can be found on the north carolina health and human services website. For students in affiliate settings that require vaccination. Phone number (enter with no dashes):