How to Fill Out and Submit the Nevada Religious Immunization Exemption Form

To claim a religious vaccine exemption in Nevada, download the Nevada religious immunization exemption form that matches your child’s setting from the Division of Public and Behavioral Health, complete the vaccine selections and the required acknowledgments, sign it, and submit it to the school or facility.¹ The form must be refiled every year, and an exempt student can still be kept out of class during a disease outbreak.

Pick the Right Form

Nevada publishes three separate religious exemption forms. Using the wrong one slows processing, so confirm which applies before you start filling anything in.

The Child Care Religious Immunization Exemption Form covers children in licensed childcare or accommodation facilities. It lists DTaP, Hepatitis A, Hepatitis B, Hib, IPV, MMR, PCV13, and Varicella. A Spanish version is also available.²
The School Religious Immunization Exemption Form covers preschool through 12th grade at public, charter, or private schools. It lists DTaP, Hepatitis A, Hepatitis B, IPV, MenACWY, MMR, Td/Tdap, and Varicella.³
The University Religious Immunization Exemption Form covers Nevada System of Higher Education students and lists only MenACWY, MMR, and Td/Tdap.⁴

All three are free downloads from the Division of Public and Behavioral Health website. A childcare exemption does not transfer when your child moves to kindergarten; you refile on the school form.

Who Qualifies

The exemption is for religious belief only. The statutes for public schools, private schools, and childcare facilities use the same language: the parent or guardian must submit a written statement indicating that their “religious belief prohibits immunization” of the child.⁵ Personal, philosophical, or scientific objections do not qualify. You are not required to name a denomination or produce a letter from clergy; the exemption rests on your own sincere religious conviction.

Public schools fall under NRS 392.437. Private schools follow the parallel NRS 394.193.⁶ Childcare is governed by NRS 432A.240.⁷ A student aged 18 or older can sign the form themselves instead of having a parent or guardian sign.³

How to Fill Out the Form

The school form, which most families will use, has three sections. You complete the first two. A school official signs the third after you turn it in.

Student and School Information

Fill in the school’s name, street address, city, zip code, and phone number. Then enter the student’s full legal name, date of birth, current grade or level, home address, and phone number. The name and date of birth should match the school’s records exactly. Mismatches cause delays.

Vaccine Selections and Acknowledgments

Check the box next to each vaccine you are declining on religious grounds. You do not have to decline every vaccine on the list; check only the ones your beliefs prohibit. Any vaccine left unchecked still has to meet Nevada’s standard schedule, so your child could be marked non-compliant on those if no vaccination record exists.³

Below the checkboxes, you must initial four separate acknowledgment statements. None of them can be skipped. Each confirms you understand a specific consequence of the exemption:

The risk of your child contracting the diseases the declined vaccines prevent.
The risk of transmitting those diseases to others.
That during a vaccine-preventable disease outbreak your child will be excluded from school for a period set by the Division of Public and Behavioral Health.
That the form must be resubmitted every year on the enrollment schedule set by the school district, charter school, or private school.

Then sign and date. A parent or guardian signs for a student under 18. A student 18 or older signs for themselves.

Section 3

Leave the third section blank. After submission, a school nurse or designee and a school board representative or designee each sign and date it to acknowledge receipt. That creates the school’s internal record that the exemption was filed.

The childcare version follows the same structure but with a different vaccine list (it adds Hib and PCV13 and drops MenACWY and Td/Tdap) and is submitted to the facility operator rather than a registrar.²

Where and When to Submit

For public schools, NRS 392.437 directs the written statement to the board of trustees of the school district or to the governing body of the charter school where the child is enrolled.⁵ In practice, most families hand the completed form to the school’s front office, registrar, or school nurse. For a private school, submit it to the school’s governing body.⁶ For childcare, hand it to the facility operator.⁷

Some larger districts accept uploads through their online registration portals. Check with the school office to confirm whether a paper copy is required or electronic submission is allowed. File before the term starts. Turning the form in after classes begin can keep your child out of school until it is on file. Keep a copy for yourself in case the original is misplaced.

Renew Every Year

The exemption does not carry over. The form states that it “must be submitted annually based on an enrollment schedule set by the school district, charter school or private school.”³ A new form, signed and submitted on your district’s enrollment timeline, is required every school year. Miss the deadline and the student can be treated as non-compliant and excluded from class until a new form is on file.

The exemption is also not permanent. The form notes that you can “re-address this issue at any time and complete the required vaccinations.” If your beliefs change or you decide to vaccinate for some diseases but not others, you can update the record with the school mid-year.

Outbreak Exclusion

Filing an exemption does not guarantee uninterrupted attendance. Under NRS 392.446, the State Board of Health or a local board of health may order an unvaccinated child excluded from school when a dangerous disease is present, and the exclusion lasts until the board determines the danger has passed.⁸ The form itself warns that the length of the exclusion is set by the Division of Public and Behavioral Health “based on a case-by-case analysis of public health risk.”³

The same rule applies at the university level. Under Nevada Administrative Code 441A.755, the university president must either require an unimmunized student to get vaccinated or exclude the student until the health authority allows return.⁹ For diseases like measles, an exclusion can run several weeks. This is the most consequential practical risk of filing an exemption, and it is one of the four statements you initial when you sign the form.

1
Nevada Division of Public and Behavioral Health. School Requirements
2
Nevada Division of Public and Behavioral Health. Child Care Religious Immunization Exemption Form
3
Nevada Division of Public and Behavioral Health. Preschool-12th Grade Religious Immunization Exemption Certificate
4
Nevada System of Higher Education. University Religious Immunization Exemption Certificate
5
Nevada Legislature. Nevada Code 392.437 – Immunization of Pupils: Exemption if Prohibited by Religious Belief
6
Nevada Legislature. Nevada Code 394 – Private Educational Institutions
7
Nevada Legislature. Nevada Code 432A – Services and Facilities for Care of Children
8
Nevada Legislature. Nevada Code 392 – Pupils
9
Nevada Legislature. NAC 441A – Infectious Diseases; Toxic Agents