How to Get and Fill Out the Texas Vaccine Exemption Affidavit

The Texas vaccine exemption affidavit is DSHS form F11-11755, and as of September 1, 2025 you can download it straight from the state health department’s website, fill it out, have it notarized, and hand it to the school. It covers the conscience exemption (which includes religious belief) for child care, K–12, and college enrollment. Once notarized, it is valid for two years.¹

Getting the Blank Form

Two options. The fast one: download the printable PDF (stock number F11-11755) from the DSHS School and Childcare Vaccine Requirements page or from immunize.texas.com, print it, and go.² DSHS is not permitted to collect any personal information from people who download the blank form.¹

If you would rather receive a paper copy in the mail, request one through the DSHS portal at co-request.dshs.texas.gov, by fax, by mail, or in person. Phone and email requests are not accepted. Include the name of the parent, guardian, or adult student, a USPS mailing address, a telephone number, and how many forms you need. Delivery takes about three weeks.³

Filling Out the Affidavit

The form has four sections. Complete everything except the signature before you go to the notary; the notary has to watch you sign.

Student information. Enter the student’s full legal name and date of birth. Each affidavit covers only the person named, so siblings each need their own form.⁴

Vaccines being declined. The form lists each vaccine separately (DTaP/DT, Hib, hepatitis A, hepatitis B, MMR, meningococcal, pneumococcal, rabies, Td/Tdap, polio, and varicella) with a checkbox next to each. Check only the ones you are declining. Any vaccine you leave unchecked is still required for enrollment. For college students, MenB or MCV5 may be used to satisfy the bacterial meningitis requirement.⁴

Acknowledgment. Nothing to write. The printed statement confirms that you understand the benefits and risks of vaccination and of declining it, and that the student may be excluded from school during an emergency or epidemic. Your signature covers it.

Signature. A parent, legal guardian, or managing conservator signs for a minor. An adult student (18 or older) signs for themselves. Do not sign until you are in front of the notary. Do not alter the form after notarization; the form itself states that additions or changes are not valid.⁴

Getting It Notarized

Notarization is not optional. A school or child-care facility will reject an affidavit without a notary seal.³ Take the completed but unsigned form and a valid government-issued photo ID to any Texas notary. Banks, UPS stores, shipping centers, and law offices commonly offer notary services, often for a small fee, and some county courthouses have notaries available.

Sign while the notary watches. The notary verifies your identity, completes the notarization block, and applies the seal. Write down the notarization date; it starts both the two-year validity clock and the 90-day submission window.

Turning It In

Deliver the original notarized affidavit to the school, child-care facility, or college. For K–12 students, Texas Education Code §38.001 requires submission no later than 90 days after the notarization date.⁵ Miss that window and the affidavit is no longer valid for enrollment; you would need a new form and a new notarization.

The school keeps the original in the student’s immunization record. Make a photocopy for yourself before you hand it over. If the school misplaces the original, having a copy makes it easier to sort out.

How Long It Lasts

The affidavit is valid for two years from the notarization date.⁶ When it expires, the exemption ends. To keep it in place, get a new blank form, complete it, have it notarized again, and submit it before the old one lapses. Schools do not send renewal reminders, so keep the date yourself.

The affidavit is tied to the individual named on it and applies only to Texas schools and child-care facilities. It does not satisfy another state’s requirements and cannot be transferred from one child to another.⁴

When the Exemption Does Not Protect Attendance

Even a valid affidavit does not guarantee the student can stay in class during an outbreak. A student who is unvaccinated because of a conscience or religious exemption may be excluded from school during an emergency or epidemic declared by the Commissioner of Public Health.⁵ The school or local public health department can also exclude the student during a locally designated outbreak.³ The acknowledgment on the affidavit itself warns of this, and your signature confirms you understand it.

College and University Students

The same DSHS form works for institutions of higher education, including students in health-related and veterinary courses.⁴ Where it comes up most is the bacterial meningitis vaccination that Texas Education Code §51.9192 requires for entering students at public and private colleges, with exceptions for online-only students and students aged 22 or older.⁷

An adult college student signs the affidavit themselves. Some colleges also offer an internet-based process for declining the bacterial meningitis vaccination specifically; check with your admissions or registrar’s office to see whether that alternative is available. Outbreak-exclusion rules apply, and for higher education students the exemption also does not apply during a declared disaster, public health emergency, or extraordinary law enforcement emergency affecting the institution’s location.⁷

Medical and Military Exemptions Use a Different Path

If the reason for skipping a vaccine is medical, do not use the DSHS affidavit. A licensed physician (M.D. or D.O.) registered in any U.S. state provides a signed, dated statement explaining that the vaccine is medically contraindicated or poses a significant risk to the student or a household member, and you submit that statement directly to the school. No notary is needed. A medical exemption is valid for one year unless the physician notes a lifelong condition.⁶ A student with a medical exemption can still be excluded during an outbreak.

People on active duty in the U.S. armed forces are exempt from the immunization requirements and do not need the DSHS affidavit; proof of active service takes its place.⁶

1
State of Texas. Texas Health and Safety Code 161.0041 – Immunization Exemption Affidavit Form
2
Texas Department of State Health Services. School and Childcare Vaccine Requirements
3
Texas Department of State Health Services. Texas Immunization Exemptions
4
Texas Department of State Health Services. Immunization Exemption Affidavit Form F11-11755
5
Texas Public Law. Texas Education Code 38.001 – Immunization; Requirements; Exceptions
6
Cornell Law Institute. 25 Texas Administrative Code 97.62 – Exclusions from Compliance
7
Texas Public Law. Texas Education Code 51.9192 – Bacterial Meningitis Vaccination Requirement for Certain Students