Vaccinations and forms
What vaccinations are included in the exemption?
Parents or guardians select the vaccines they are requesting a religious exemption for on the form 139-R. Parents/guardians can select the specific vaccines for which their religious belief led them to seek exemption.
Do I have to have the exemption form complete before school starts?
Schools are required to have a form 121 (immunization) or 122 (exemption) from each enrolled student. Parents/guardians should speak with their school regarding specific requirements for when these forms are due. Schools may refer to the Memo from State Epidemiologist dated 7/20/23.
What if I cannot get this done prior to the first day of school?
Schools are required to have a form 121 (immunization) or form 122 (exemption) from each enrolled student. Parents/guardians should speak with their school regarding due dates and their policies for students who lack a form 121 or form 122. Schools may refer to the Memo from State Epidemiologist dated 7/20/23.
Will I receive some sort of documentation to present to the school/daycare?
Once the parent or guardian has completed the process, the completed form will be reviewed by MSDH staff and the approved exemption form will be sent to the parent and the child’s school if school information has been provided. If the parent/guardian does not provide school information on the request form, the parent will be responsible for submitting the exemption form 122 to the school.
How long will it take for the school/daycare to receive the Certificate?
Once the completed exemption form is approved by MSDH staff, it will be sent to the parent and the child’s school if school information has been provided. The length of time will depend on the number of forms being processed by MSDH and whether the parent/guardian provided email addresses and contact information for themselves and the school. (If the parent/guardian does not provide school information on the request form, the parent will be responsible for submitting the exemption form 122 to the school.)
What if I lose my exemption form?
Parents or guardians may contact the MSDH Office of Immunizations to request a replacement copy of their form: 601-576-7751
Will I have to complete an exemption request every year?
The religious exemption 122 is a permanent exemption. However, a copy of the exemption form is required to be turned in to the child’s school each year.
Schools, after-school care, and daycare
Do I need an exemption form for daycare?
Children enrolled in licensed childcare facilities are required to have form 121 or 122 documenting required vaccinations or exemption.
Do I need an exemption form for after-school care?
Children properly enrolled in a Summer Day Camp or School Age Program are not required to have a Certificate of Immunization Compliance (form 121) in their record. Parents or guardians should consult with their after-school care program for their specific requirements.
Do I need an exemption form for private school?
Yes. Children enrolled in K-12 schools (including private schools) are required to have form 121 or 122 documenting required vaccinations or exemption.
Does my homeschooled child need an exemption form?
Homeschooled children do not require proof of exemption or vaccination provided the homeschool setting meets the definition of a home instruction program as defined in Section 37-13-91 of the Mississippi Code of 1972 and has 10 or fewer children who are related to the operator within the third degree, computed according to civil law.
About appointments
What happens during the appointment at the health department?
Upon arrival at the health department for the scheduled appointment, the parent or guardian will complete the check-in process for the child for whom the exemption is requested. This is the same process used for all clinic visits at the health department and includes filling out a registration form, notice of privacy practices, and consent to treat. Once the child is checked in and an electronic health record is created, the parent or guardian will be shown an educational video on vaccinations. Following the video, the nurse will ensure that the religious exemption request form is complete and will provide additional information and an opportunity for the parent or guardian to ask questions. Once the nurse completes the form, it will be sent by health department staff to the Office of Immunizations for processing.
How long will the appointment last?
The visit will include check-in for the appointment, collection of basic demographic information (particularly if the patient is new), watching a brief educational video, a brief consultation with the nurse, and then completion and receipt of the religious exemption request form.
What will I need to bring with me to the appointment?
If able, you can print the form 139-R (Request for Religious Exemption) and have the top portion completed in advance of your visit. If you are not able to print this form, it will be provided at the time of your appointment. The parent or guardian is asked to bring a valid photo ID, such as a driver’s license.
Does the child have to come to the appointment?
Yes.
Can all of my children be seen in the same appointment?
Each child will need to be scheduled for an appointment for documentation purposes, but if the visits are scheduled at the same date and time, the parent or guardian will only need to watch the educational video once. (If the parent or guardian schedules an appointment for exemption for another child on another date, they will be required to watch the video at that time as well.)
To make an appointment call our scheduling center at 855-767-0170
