To claim a religious vaccine exemption for your child in Kentucky, you complete the Kentucky EPID-230A religious exemption form, officially the “Commonwealth of Kentucky Parent or Guardian’s Declination on Religious Grounds to Required Immunizations.” You mark the vaccines you’re refusing, initial the religious objection statement, sign it in front of a notary public, and file the notarized form with your child’s school or childcare provider. Once accepted, it takes the place of the standard immunization certificate (EPID-230) for the vaccines you’ve declined.1Cabinet for Health and Family Services. FAQs: EPID-230 and EPID-230A Forms
What the Form Does and Who Can Use It
The EPID-230A is Kentucky’s only religious vaccine declination. Under KRS 214.036, a parent or legal guardian who is religiously opposed to immunization may file a written, sworn statement in place of the immunization certificate.2Kentucky Cabinet for Health and Family Services. Commonwealth of Kentucky Parent or Guardian’s Declination on Religious Grounds to Required Immunizations The sworn statement is the EPID-230A.
Kentucky offers no philosophical or personal-belief exemption. Your two options for bypassing the standard vaccine requirements are this religious declination or a medical exemption documented by a licensed provider on the EPID-230 itself. If your objection is medical rather than religious, EPID-230A is the wrong form.
How to Fill Out the EPID-230A
Download the form as a PDF from the Kentucky Cabinet for Health and Family Services website, or ask your school or local health department for a printed copy. It’s one page, and every field matters. An incomplete form will come back to you.
Child’s Information
At the top, enter your child’s last name, first name, and middle name, with the date of birth in MM/DD/YYYY format. There’s no field for your address or phone number; that information lives on the EPID-230.2Kentucky Cabinet for Health and Family Services. Commonwealth of Kentucky Parent or Guardian’s Declination on Religious Grounds to Required Immunizations
Mark the Vaccines You’re Declining
The body of the form lists each vaccine-preventable disease covered by Kentucky’s immunization schedule under 902 KAR 2:060: diphtheria, tetanus, and pertussis; polio; measles, mumps, and rubella; hepatitis B; hepatitis A; varicella; and meningococcal disease.3Kentucky Legislative Research Commission. 902 KAR 2:060 – Immunization Schedules for Attending Child Day Care Centers, Certified Family Child Care Homes, Other Licensed Facilities Which Care for Children, Preschool Programs, and Public and Private Primary and Secondary Schools Place an “X” in the box next to each disease you are declining, then initial and date the line beside each selection. Marking a disease declines the entire vaccine series for that disease; you don’t need to count doses.
If you object to all listed vaccines, mark every box. If you object to only some, mark only those. For the ones you aren’t declining, you’ll still need an EPID-230 on file showing those vaccines were administered.2Kentucky Cabinet for Health and Family Services. Commonwealth of Kentucky Parent or Guardian’s Declination on Religious Grounds to Required Immunizations
Initial the Religious Objection Statement
Below the disease list is a statement affirming that your objection is based on religious grounds, as required by KRS 214.036. Read it, then initial it. This is separate from your signature at the bottom. Both are required.
Sign in Front of the Notary
Sign your full legal name and write the date. Don’t sign ahead of time. The notary needs to witness the signature or have you acknowledge it in person.
Getting It Notarized
The EPID-230A is not valid without notarization. KRS 214.036 requires a sworn statement, and the form includes a dedicated notary block where the notary acknowledges your signature under oath.2Kentucky Cabinet for Health and Family Services. Commonwealth of Kentucky Parent or Guardian’s Declination on Religious Grounds to Required Immunizations
You can find notary services at most banks, UPS stores, courthouses, and some local health departments. Kentucky removed its statutory cap on notary fees, so cost varies. Many banks notarize free for account holders. Bring a valid government-issued photo ID; the notary has to verify your identity before completing the notarization.
Where and When to Submit It
After notarization, take the EPID-230A to the administrative office of your child’s school, childcare center, or preschool. Most facilities want the original paper form in person. Some districts allow scanned uploads through a parent portal, but check with the registrar first because not all schools accept digital copies of notarized documents.
Kentucky sets firm deadlines. For public and private primary and secondary schools, the form must be on file within two weeks of the child’s first day of attendance. For daycare centers, certified family childcare homes, and other licensed childcare facilities, the deadline is thirty days from admission.4Justia Law. Kentucky Revised Statutes 214.034 Miss the deadline and the child can be excluded from attendance until the paperwork is in.
If Your Child Has Had Some Vaccines
Partial declinations are common. For the vaccines your child has received, a licensed provider completes and signs an EPID-230 covering those doses, and the school files it alongside your EPID-230A. If you need the dates and don’t have them, request records through the Kentucky Immunization Registry public portal, or ask your pediatrician or local health department for a printout.5Kentucky Immunization Registry. Immunization Record Info Request
When You Need to File a New Form
The EPID-230A itself doesn’t expire. As long as the notary was actively commissioned when they signed, the notarization is valid indefinitely. You need a new, re-notarized form in three situations:1Cabinet for Health and Family Services. FAQs: EPID-230 and EPID-230A Forms
- A new vaccine is added to the required schedule and wasn’t on your original form.
- You change your mind about one of the vaccines you previously declined. File an updated EPID-230A listing only the vaccines you still object to, plus an EPID-230 recording the newly administered doses.
- 902 KAR 2:060 is amended in a way that affects the declination process.
You can’t amend the original. Each updated form needs its own notarization.
Outbreak Exclusion
Filing an EPID-230A does not guarantee uninterrupted attendance. If the county or state health department declares an outbreak of a vaccine-preventable disease, any child who cannot show proof of immunity to that disease can be excluded from school or childcare for up to three weeks or until the risk period ends, whichever comes first.2Kentucky Cabinet for Health and Family Services. Commonwealth of Kentucky Parent or Guardian’s Declination on Religious Grounds to Required Immunizations The notice appears on the form itself, and your signature acknowledges it. The school has no discretion once the health department issues the declaration; exclusion is automatic for unvaccinated students.