Vaccine Exemption Form Utah - Give the exemption form to the school your child attends. Attach a copy of the exemption form to the back of the usir. (a) develop a vaccination exemption form that includes only the following information: Click “download” to view and print the vaccination exemption form. Select the vaccines that apply to the exemption. The student to whom an exemption applies; To receive a vaccination exemption form, the legally responsible individual who claims the exemption for the student must complete the online immunization education module. To access the online immunization education module, click here. Fill in the exemption column with the type of exemption (religious, personal, or medical) if the student has an exemption. Must click all that apply.
Must click all that apply. To receive a vaccination exemption form, the legally responsible individual who claims the exemption for the student must complete the online immunization education module. The student to whom an exemption applies; (a) develop a vaccination exemption form that includes only the following information: Web to receive a utah vaccination exemption form, a legally responsible individual of a child must complete the online education module, print the utah vaccination exemption form and provide a signed copy to the school/early childhood program. To access the online immunization education module, click here. Submit completed form to email: Attach a copy of the exemption form to the back of the usir. Click “download” to view and print the vaccination exemption form. For a medical exemption, a written notice signed by a licensed health care provider must also be attached to the usir. Web immunization exemption request for university of utah health. Fill in the exemption column with the type of exemption (religious, personal, or medical) if the student has an exemption. Select the vaccines that apply to the exemption. Give the exemption form to the school your child attends.