To claim a Tennessee religious exemption from vaccination for your child, complete either the Tennessee Department of Education’s Religious Exemption from Vaccination form (ED-5379) or the religious exemption section of the Department of Health’s Certificate of Immunization (PH-4103), sign the declaration under penalty of perjury, and file it with your child’s school before enrollment. The exemption comes from Tennessee Code Annotated § 49-6-5001(b)(2) and applies to public schools, private schools, nursery schools, preschools, and licensed childcare facilities across the state.1Justia. Tennessee Code 49-6-5001 – General Provisions No doctor’s signature is needed, no notary, and no state agency reviews or approves the request.
Which Form You Need
Tennessee has two official documents that can carry a religious exemption, and which one you use depends on your child’s vaccination history and your school’s preference.
Form ED-5379, the Religious Exemption from Vaccination, is the simpler option. It exists solely to document the parent’s religious objection, cites TCA § 49-6-5001(b)(2) directly, and contains the declaration: “I am declining vaccination(s) for my child because the vaccinations conflict with my religious tenets and practices.”2Tennessee Department of Education. Religious Exemption from Vaccination It asks only for the child’s name, the parent or legal guardian’s name and address, and the parent’s dated signature. No provider signature and no vaccination history.
Form PH-4103, the Certificate of Immunization, is the standard immunization record every Tennessee child needs on file at school.3Tennessee Department of Health. Certificate of Immunization It includes a checkbox for religious exemption that a healthcare provider marks to explain absent or incomplete immunization information.4Tennessee Department of Health. Immunization Requirement Summary for Child Care Through 12th Grades Use PH-4103 when your child has already received some vaccines and you are declining the rest: a physician, physician assistant, advanced practice nurse, or public health nurse records the doses given and checks the religious exemption box for the remainder.
Some schools accept ED-5379 on its own. Others want it alongside a PH-4103 showing any vaccines the child has received. Call the school’s registrar or enrollment office before you start so you complete the right paperwork the first time.
What Goes on the Form
Whichever form you use, the entries are straightforward, and accuracy matters because mismatches with school enrollment records slow processing.
- Child’s full legal name and date of birth, exactly as they appear on enrollment paperwork.
- Parent or legal guardian’s full name and address.
- Parent’s signature and the date signed.
The signature is the operative part. You are affirming under penalty of perjury that vaccination conflicts with your religious tenets and practices.1Justia. Tennessee Code 49-6-5001 – General Provisions This is a legal declaration, not a preference checkbox, and a false statement can carry consequences. The statute does not require you to belong to any particular church, denomination, or organized religious group; the objection is personal to you as the parent or guardian.
Notarization is not required. Neither form has a notary block, and the statute does not mention one. The signed perjury affirmation is the only authentication the law demands.2Tennessee Department of Education. Religious Exemption from Vaccination
You can exempt from all required vaccinations or only specific ones. If your child has received some vaccines but you object to others, the exemption covers only the ones you decline, and the PH-4103 will show that split clearly.
Where to Get the Form
Ask your school’s enrollment office, your local county health department, or your child’s pediatrician for a copy of either form. The PH-4103 is also available through the Tennessee Immunization Information System at tennesseeiis.gov.3Tennessee Department of Health. Certificate of Immunization The ED-5379 is a Tennessee Department of Education form distributed through schools.
Filing the Form With the School
Deliver the completed form to the school’s admissions office, registrar, or childcare director. Most families do this during registration or before the first day of the school year.
Timing is not optional. Under TCA § 49-6-5001(c)(1), no child can attend any school or childcare facility until proof of immunization, or a valid exemption, is on file with the admissions officer.1Justia. Tennessee Code 49-6-5001 – General Provisions Filing after enrollment has started can mean your child is temporarily excluded until the paperwork is in order.
The school keeps the certificate in the student’s file for the duration of attendance. The Tennessee Department of Health does not track or grant religious exemptions; the process happens entirely at the school level, and no state agency approval is required beyond the school accepting the form.5Tennessee Department of Health. Vaccine Preventable Diseases and Immunization Program Because local procedures vary by district, contact your specific school if you have questions about documentation.
When the Exemption Doesn’t Apply
The religious exemption has a limitation written into the statute. It applies only “in the absence of an epidemic or immediate threat of an epidemic.”1Justia. Tennessee Code 49-6-5001 – General Provisions If public health officials declare an epidemic or determine one is imminent, the exemption effectively suspends, and unvaccinated children can be kept out of school until the threat passes.
The statute sets no fixed exclusion period; it depends on the disease. For measles outbreaks, Tennessee school districts have planned for exclusion periods of 21 to 28 days for unvaccinated students.6WSMV. Tennessee School Districts Prepare in Case of Measles Outbreak The exclusion is temporary and tied to the active threat, not a permanent revocation of the exemption.
One vaccine sits outside the requirement entirely: subsection (b)(3) states that the immunization requirement does not apply to vaccines for SARS-CoV-2 or any variant.1Justia. Tennessee Code 49-6-5001 – General Provisions Tennessee does not require COVID-19 vaccination for school attendance, so no exemption is needed for that vaccine.
College Students
If you are looking for the exemption at the college level, the paperwork is different. Under the Jacob Nunley Act (TCA § 49-7-124), new students living in on-campus housing at public colleges and universities must show proof of meningococcal vaccination, and the student, or a parent or guardian if the student is a minor, can claim a religious exemption through a written statement under penalty of perjury.7Justia. Tennessee Code 49-7-124 – Jacob Nunley Act – Requirement of Proving Immunization Against Meningococcal Disease – Exemptions
Individual universities often set broader requirements. The University of Tennessee system requires MMR, varicella, and meningococcal vaccines and accepts religious exemptions through a written perjury-affirmed statement, though clinical and health-science programs may deny exemptions when patient safety or a training site’s rules require vaccination.8University of Tennessee. University of Tennessee Immunization Rules 1720-01-17 Confirm your specific program’s policy before relying on the statutory exemption alone.