little Blessings Nursery School

Learn & Grow through Play & Faith.

Immunization Request Forms and Affadavits

This will link you to the Immunization Information Request Form that we need to go with your child's Immunization Record

This is the link to the affidavit you will need to fill out and have signed by a Commissioner of Oath (eg. notary public, town clerk, Member of Parliament, lawyer, judge, and/or justice of the peace) for exemption from Immunization

For reasons of Conscience or Religious Belief$File/3042E.pdf

This is the link to the Statement of Medical Exemption of Immunization that must be completed by a Doctor or Nurse Practitioner$File/3041E.pdf