2011 School and Child Care Immunization Exemption Law

Frequently Asked Questions

State law requires that before attending a licensed child care or school, children must be immunized against certain diseases that can be prevented by vaccinations. Parents and guardians meet this requirement by filling out and turning in a Certificate of Immunization Status form, showing their child has the required vaccinations (or that they have already had the illness and are now immune).

If parents and guardians choose to exempt their child from one or more of the required vaccines, they must fill out a Certificate of Exemption form.

The 2011 Washington State Legislature passed a law that changes the process for getting an immunization exemption. All other parts of the law are the same. The questions and answers below give parents, schools, child cares, and public and private health care providers the information they need to follow the steps in the exemption process correctly.

General Information
Effective Date
Requirements and Process
Religious Exemptions
Changing the Exemption Form

General Information

Q: What does the new law change?
A: The new law says that if a parent or guardian wants to exempt their child from school or child care immunization requirements, they must first get information about the benefits and risks of vaccinations from a licensed health care provider. The provider will sign the Certificate of Exemption form that parents have to turn in to the school or child care to exempt their child. Instead of signing the form, providers may choose to write and sign a letter verifying the same information.

Parents or guardians who demonstrate membership in a church or religious body that does not believe in medical treatment do not have to have a health care provider sign the exemption form.
Q: Why is the law important?
A: Washington has one of the highest school exemption rates in the nation, in part because our exemption policy made convenience exemptions easy to claim. The law makes sure exemptions are based on conviction, not convenience.

Immunizations save lives. Diseases can spread quickly in schools and child cares and unfortunately we have had outbreaks of whooping cough, chickenpox, and other disease in our state. Unimmunized children are more likely to get a disease that vaccines can prevent and spread it in their communities.

When children have exemption forms on file at school and an outbreak happens, the kids with exemptions must be sent home until the outbreak is over, until they bring in their vaccination records, or until they get vaccinated. This causes disruption in schools, classrooms, and a child’s learning. Having fewer convenience-based exemptions will reduce the burden on our schools.
Q: How can schools, licensed child cares, health care providers, and parents or guardians make sure they meet all the new requirements?
A: Beginning July 22, 2011, schools, child cares, providers, and parents must use the updated exemption form to meet the new requirements.
Q: Does the new law change any required immunizations for school or child care entry?
A: No, the vaccines required for school and child care entry are the same.
Q: What’s the definition of “conditional” status according to school and child care requirements?
A: Kids are in “conditional” status if they do not have one or more required vaccines on their first day of attendance or, in some cases, after they’ve begun school or child care. These kids can attend school or child care for a limited time until they finish their paperwork. From the time they get notified that their child has conditional status, parents or guardians have 30 days to get the child vaccinated, show a record of past vaccination, or exempt their child for the missing vaccine
Some kids may not have immunizations which are part of a series with recommended intervals between doses. In these cases, the child will remain in conditional status as long as necessary to complete the series according to national immunization guidelines. In all other cases, if a parent does not take action within 30 days, the child must be excluded from school or child care. Children with completed exemption forms do not have “conditional” status. See WAC 246-105-020 and 246-105-060 for more information.

Effective Date

Q: When do these changes take effect?
A: The law took effect July 22, 2011, and applies only to exemptions that parents or guardians claim on or after this date.
Q: Are new exemption forms turned in before the law’s effective date still allowed?
A: Yes, the new exemption form is ready and can be used before July 22, 2011.
Q: What about kids who have registered for child care or school, but won’t start school until the fall of 2011? Do they need a new exemption form?
A: No. As long as their exemption form was submitted to the school before July 22, 2011, it’s valid even if the child begins school or child care after that date.
Q: If schools or preschools are closed during the summer, can parents or guardians drop off the exemption form at a school district office?
A: No. As part of the enrollment process, immunization records must be given to the school in which the child will attend. Parents or guardians who aren't able to submit an exemption form before July 22, 2011 due to school or preschool closure will need to submit an exemption form under the new requirements when the school or preschool opens.
Q: Will parents have to redo an exemption from previous years?
A: An exemption form on file at a school or licensed child care that was turned in before July 22, 2011 is still valid for the exemptions indicated on that form. But, as kids progress through school, their parents or guardians may request additional exemptions to meet age-appropriate immunization requirements. At that time a new exemption form will have to be turned in for any additional exemption.
Q: Will children transferring schools within Washington State with an exemption(s) from previous years need to renew the exemption(s) under the new requirements?
A: No. Any exemption received in Washington State before July 22, 2011 is still valid regardless of which school or school district the child attends.

Requirements and Process

Q: How does a health care provider verify they gave a parent or guardian information about immunization benefits and risks?
A: Health care providers can sign the pre-written statement on the exemption form or write and sign a letter verifying the same thing.
Q: Does a parent or guardian always have to sign the exemption form?
A: Yes, a dated parent or guardian signature must be on the exemption form for any type of exemption in order to be valid.
Q: Can families who live near Washington State borders who have medical homes in Idaho or Oregon have their out-of-state health care provider sign the exemption form or write a letter?
A: Yes, but only if that provider is also licensed in Washington State. Providers who don't hold a Washington State medical license cannot sign the exemption form or write a letter, regardless of where they live or work.
Q: What kind of health care providers can sign the exemption form or write a letter?
A: Physicians (M.D.), physician assistants (P.A.), osteopaths (D.O.), naturopaths (N.D.), and advanced registered nurse practitioners (A.R.N.P.) who are currently licensed in Washington are authorized to sign the exemption form or write a letter. Signatures by registered nurses (R.N.) or licensed practical nurses (L.P.N.) are not acceptable.
Q: Does a provider have to give vaccinations in order to sign the exemption form or write a letter?
A: Any qualified provider currently licensed in Washington may sign the exemption form.
Q: Do parents or guardians have to attach the benefit and risk information they get from their provider to the exemption form?
A: No, the provider signs the exemption form to verify the information was shared. Schools and licensed child cares will have to check that the provider signed the form or letter.
Q: Does this create a cost for parents or guardians because they must make an appointment to get a provider signature?
A: If health care providers and parents have already talked about benefits and risks of vaccination, an office visit may not be necessary for providers to sign the exemption form. Providers can sign it at any time before the child attends school or child care, such as during already scheduled well-child visits or sports physicals.
Q: Does a provider have to sign the exemption form (or sign a letter) for all types of exemptions?
A: Providers must sign the statement on the exemption form about providing benefit and risk information (or sign a letter) for most types of exemptions. The only exception to this requirement is that a provider doesn’t have to sign the form or letter for a parent or guardian who demonstrates membership in a church or religious body that does not allow medical treatment.
Q: What does a provider have to do to verify a medical exemption?
A: For an acceptable medical exemption under the new law, the provider must sign the exemption form twice; once indicating the specific medical exemption and type (temporary or permanent medical exemption) and once to confirm the parent has received the benefit and risk information.
Q: What does the provider letter have to include?
A: It must explain that the parent or guardian received information on the benefits and risks of immunizations, reference the child’s name, and be signed by a qualified health care provider. If the letter has these three things, schools and licensed child cares may accept it in place of a provider signature on the actual exemption form.
Q: Are copies and faxes of the signed exemption form acceptable?
A: Yes, schools and child cares can accept copies and faxes of the new exemption form. If anything on the form is not filled out correctly, they must let the parent or guardian know as soon as possible.
Q: Is a copy or fax of the provider letter acceptable?
A: Yes, as long as the letter meets the three minimum requirements as explained above. Make sure the provider letter gets stapled to the exemption form and that a parent or guardian also signs the exemption form.
Q: Are health care providers legally obligated to sign the exemption form?
A: No, it’s up to each provider to decide if they’re willing to sign the exemption form. This is between parents and their health care provider.
Q: Can providers get sued (by a parent or guardian, for example) if they sign the exemption form and the child gets sick with a vaccine-preventable disease?
A: No. The new law states that providers signing the form in good faith are not at risk of legal action.

Religious Exemptions

Q: Are all religious exemptions acceptable without the provider’s signature?
A: No. Most parents or guardians checking the box for a religious exemption must first get information about the benefits and risks of vaccinations from a licensed health care provider. Only parents or guardians who demonstrate membership in a church or religious body that does not allow medical treatment (in Box 2 of the form) do not need a provider to sign.
Q: How does a parent or guardian demonstrate membership in this kind of church or religious body?
A: In Box 2 of the exemption form, the parent or guardian must sign a prewritten statement to indicate they belong to a church or religious body that does not believe in medical treatment from a health care provider. They will also have to write in the name of the church or religious body. Parents or guardians must have both of these (their signature and the name of their church or religious body) to claim this type of religious exemption.
Q: Does the parent or guardian have to supply additional information, such as copies of church doctrine, church addresses, or signatures from the religious leadership?
A: No, nothing else will be required as proof of membership or of their religious affiliation.
Q: What if the parent or guardian refuses to write in the name of their church or religious organization in Box 2 of the form?
A: Then the parent or guardian cannot receive this type of religious exemption. They must get the required health care provider signature on the exemption form or a letter confirming they have received the benefit and risk information on immunizations.
Q: What if schools or licensed child cares do not recognize the name of the religious body the parent or guardian writes in Box 2 of the exemption form?
A: Schools and child cares do not have to verify the religious organization or religious belief, even if the name is unknown or seems false.

Changing the Exemption Form

Q: What if the parent or guardian seeks an exemption, but the provider, school, or licensed child care notices from previously provided information that the child has already been vaccinated?
A: The provider, school, or licensed child care should explain the situation to the parent and let them know the exemption isn’t necessary. This will likely resolve the situation. If the parent or guardian still wants an exemption, and he or she supplies the proper information on the exemption form, the exemption must be accepted.
Q: If a provider, school, or licensed child care discovers a child has already received a vaccine for which he or she is currently exempted, can the child’s exemption be deleted?
A: No. State law requires that the parent or guardian approve the change before the exemption gets deleted. The person who looks over the exemption form (usually school or child care staff, but it could also be a provider) needs to get the parent’s approval for the change. The form can then be updated with the new information, including the date when the parent approved the change.

Last Update: 09/14/2011 10:03 AM

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