The Maryland vaccine exemption form is MDH Form 896, the state Immunization Certificate, which doubles as the only document Maryland accepts for claiming either a medical or religious exemption from school and childcare vaccine requirements. You fill out the top identifying section for your child, skip the immunization dose table if you’re claiming a full religious exemption, and then complete either the medical contraindication section (signed by a physician or local health department official) or the religious objection section (signed by you as the parent or guardian). Maryland does not offer a philosophical or personal-belief exemption; those two boxes are the only routes.
Where to Get the Form
The current version, revised June 2025, is a free PDF on the Maryland Department of Health’s immunization page.1Maryland Department of Health. MDH Form 896 – Immunization Certificate Pediatricians, family doctors, and local health departments keep blank copies. Some districts, including Montgomery County Public Schools, host the form on their own registration pages.2Montgomery County Public Schools. Maryland Department of Health Immunization Certificate The form itself warns that it “may not be altered, changed, or modified in any way,” so print it exactly as issued.
Which Exemption You Can Claim
Maryland recognizes two exemptions and no others. A medical exemption requires a documented contraindication signed by a licensed physician or local health department official. A religious exemption is based on the parent’s sincerely held religious beliefs and is signed by the parent alone.1Maryland Department of Health. MDH Form 896 – Immunization Certificate There is no personal-belief or philosophical option on the form, and no separate application exists outside of MDH 896.
The two exemptions work very differently in practice. A medical exemption can be vaccine-specific: if only one shot is contraindicated, your child still needs the others. A religious exemption is all-or-nothing. The pre-printed language says “any vaccine(s) being given to my child,” and the form has no checkboxes for selecting individual vaccines.
Completing the Religious Objection Section
The religious section sits at the bottom of the form and is the simpler of the two to complete. You fill it out yourself. No doctor, clergy letter, or supporting statement is required. The pre-printed text reads: “I am the parent/guardian of the child identified above. Because of my bona fide religious beliefs and practices, I object to any vaccine(s) being given to my child.”1Maryland Department of Health. MDH Form 896 – Immunization Certificate You sign and date underneath. That is the whole section.
Maryland law does not require membership in any specific denomination or organized religion. The standard focuses on the sincerity of the parent’s beliefs rather than the doctrines of a particular faith.3Maryland General Assembly. Maryland Code Health-General 18-403
One limitation is printed on the form itself: “This exemption does not apply during an emergency or epidemic of disease.”1Maryland Department of Health. MDH Form 896 – Immunization Certificate If the Secretary of Health declares an outbreak, the religious exemption is suspended and the school can exclude your child until the emergency ends.4Maryland Regulations. Chapter 04 School Health Services and Required Immunizations
Completing the Medical Contraindication Section
The medical section sits just above the religious section. A licensed physician or local health department official must fill it in and sign it. A parent cannot complete this part.1Maryland Department of Health. MDH Form 896 – Immunization Certificate The signature line is labeled “Medical Provider / LHD Official,” so bring the form to your child’s doctor or your county health department.
The provider checks one of two boxes: permanent or temporary contraindication. For a temporary contraindication, the provider fills in the date by which the child is expected to be able to receive the vaccine, and writes which specific vaccines are contraindicated along with the medical reason.4Maryland Regulations. Chapter 04 School Health Services and Required Immunizations
A temporary medical exemption is not a one-and-done filing. Once the estimated date passes, you must give the school evidence that your child received the immunization or a new statement extending the exemption.4Maryland Regulations. Chapter 04 School Health Services and Required Immunizations Keep the follow-up date on your calendar.
Filling In the Student Information
The top of the form collects the child’s last name, first name, middle initial, address, city, ZIP code, sex, date of birth, county, school name, and current grade, plus the parent or guardian’s name and phone number for minors. Fill every field in ink. Make sure the name and date of birth match the child’s enrollment records exactly. A mismatch is the most common reason a school flags the form during intake.
The Immunization Record Table
Below the identifying section is the dose table, which lists DTP/DTaP/DT, polio, Hib, hepatitis B, PCV, rotavirus, MCV, HPV, hepatitis A, MMR, varicella, COVID-19, Td, Tdap, MenB, and an “Other” row. If your child has received some vaccines and you are claiming an exemption only for others through a medical contraindication, record the doses that were given in month/day/year format. Checkmarks are not accepted. The provider who administered the shots enters the dates and signs the certification section. A different medical provider, local health department official, school official, or childcare provider can also transcribe dates from another authenticated record and sign.1Maryland Department of Health. MDH Form 896 – Immunization Certificate
For a full religious exemption, the dose table can be left blank; the signed religious objection is what the school files.
Submitting the Form
Deliver the completed form to the school’s front office, registrar, or school nurse during the enrollment or registration period. Some districts accept digital uploads through enrollment portals, but many still require the original paper form, so check before scanning. Keep a photocopy or clear photograph for your own records before handing over the original.
A school official reviews the form to confirm every required field is complete and all necessary signatures are present. If something is missing, such as an unsigned medical section, a blank date of birth, or an illegible entry, the form goes back to you and your child may not be admitted until you return a corrected version. Once accepted, the certificate goes into your child’s permanent school health file.1Maryland Department of Health. MDH Form 896 – Immunization Certificate
If You Cannot Submit the Form on Day One
Maryland allows temporary admission under limited circumstances. Your child can attend if you show evidence of a scheduled appointment with a healthcare provider or local health department to receive missing vaccines, reconstruct a lost record, or obtain evidence of immunity. That appointment must fall within 20 calendar days of the temporary admission date. The grace period is not renewable. If you do not provide the required evidence by the day after the scheduled appointment, the school must exclude your child on the next school day.5Cornell Law Institute. Md Code Regs 10.06.04.06 – Temporary Admission or Retention Homeless students also qualify for temporary admission under this provision.
If your child later transfers to a different school in Maryland, the new school will need to see the original certificate or a certified copy. The backup you kept when you first submitted the form is what makes that transfer painless.