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    Religious and Medical Exemption Declaration. K-12 School. Blank General Shell

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    Emanuel McCray
    1. I assert that my family has sincerely held religious and medical beliefs and convictions that prevents the minor child named above from wearing all “non-medical” face masks and face coverings, and from receiving any of the COVID-19 vaccines and booster shots that are publicly known to the school to be capable of causing the death of a human; has caused the deaths of thousands of humans of various ages; or has inflicted serious bodily harm on thousands of humans.

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    Religious and Medical Exemption Declaration. K-12 School. Blank General Shell

    Uploaded by

    Emanuel McCray
    52 views1 page
    1. I assert that my family has sincerely held religious and medical beliefs and convictions that prevents the minor child named above from wearing all “non-medical” face masks and face coverings, and from receiving any of the COVID-19 vaccines and booster shots that are publicly known to the school to be capable of causing the death of a human; has caused the deaths of thousands of humans of various ages; or has inflicted serious bodily harm on thousands of humans.

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    1. I assert that my family has sincerely held religious and medical beliefs and convictions that prevents the minor child named above from wearing all “non-medical” face masks and face coverings, and from receiving any of the COVID-19 vaccines and booster shots that are publicly known to the school to be capable of causing the death of a human; has caused the deaths of thousands of humans of various ages; or has inflicted serious bodily harm on thousands of humans.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    52 views1 page

    Religious and Medical Exemption Declaration. K-12 School. Blank General Shell

    Uploaded by

    Emanuel McCray
    1. I assert that my family has sincerely held religious and medical beliefs and convictions that prevents the minor child named above from wearing all “non-medical” face masks and face coverings, and from receiving any of the COVID-19 vaccines and booster shots that are publicly known to the school to be capable of causing the death of a human; has caused the deaths of thousands of humans of various ages; or has inflicted serious bodily harm on thousands of humans.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
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    CONFIDENTIAL—NATIONAL SECURITY INFORMATION

    COVID-19 K-12 STUDENT


    RELIGIOUS AND MEDICAL EXEMPTION DECLARATION (REQUEST
    FOR EXEMPTION)

    School/Institution:___________________________________________________

    ________________________________ _______________________________
    Student Name ID No.
    ________________________________
    District/Location

    DECLARATION:

    1. I assert that my family has sincerely held religious and medical beliefs and
    convictions that prevents the minor child named above from wearing all “non-
    medical” face masks and face coverings, and from receiving any of the COVID-19
    vaccines and booster shots that are publicly known to the school to be capable of
    causing the death of a human; has caused the deaths of thousands of humans of
    various ages; or has inflicted serious bodily harm on thousands of humans as
    reported in the Federal Vaccine Adverse Event Reporting System (“VAERS”).

    I declare under penalty of perjury under the laws of the State of __________

    that the foregoing is true and correct.

    Date: _________________________ _________________________________


    Parent/Guardian Signature
    Place: ________________________ _________________________________
    Print Name

    SCHOOL/INSTITUTION PLEASE COMPLETE THIS SECTION

    ____Approved ____Denied Date:________________________

    Officer/Agent: __________________________Title:______________________

    CONFIDENTIAL—NATIONAL SECURITY INFORMATION

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