Tennessee Vaccine Exemptions: Types, Denials, and Penalties

Tennessee vaccine exemptions come in two forms for students: a medical exemption backed by a licensed physician’s written certification, and a religious exemption based on a signed statement from the parent or guardian affirmed under penalty of perjury. Both are authorized by a single state statute that applies to public schools, private schools, preschools, nursery schools, and licensed child care facilities. Home schools sit outside the statute entirely.¹ Workers seeking exemptions rely on a different set of rules, primarily federal.

What Tennessee Actually Requires

The Tennessee Commissioner of Health sets the immunization list, and the required shots vary by grade level.²

Kindergarten: Hepatitis B, DTaP, polio (final dose at or after age four), two doses each of MMR and varicella, and two doses of Hepatitis A.
Seventh grade: A Tdap booster given at or after age ten, plus updated varicella requirements.
New enrollees in other grades: DTaP, two doses each of MMR and varicella, polio (final dose at or after age four), and Hepatitis B.
College students: Two doses each of MMR and varicella (with birth-year cutoffs), meningococcal vaccine for students under 22 living in on-campus housing at public institutions, and Hepatitis B for health science students expecting patient contact.

The same list applies whether a child is entering a public school, a private school, or a licensed day care.¹

Medical Exemptions

A child who cannot safely be vaccinated qualifies for a medical exemption when a licensed physician provides written certification that immunization is medically contraindicated. The certification has to identify the specific medical reason.¹ Conditions that commonly support an exemption include severe allergic reactions to vaccine components, compromised immune systems, and other contraindications recognized in CDC or vaccine manufacturer guidance.

Tennessee does not publish a mandatory state form for this purpose. The physician’s signed certification goes to the school or child care facility’s admissions office, which keeps it in the student’s immunization file. Because a child’s health can change, a school may revisit whether a medical exemption still applies.

Religious Exemptions

The religious exemption is available when immunization conflicts with the parent or guardian’s religious tenets and practices. The paperwork is simple: a signed written statement, submitted to the school. What sets it apart is the language attached to it. The statute requires the statement to be “affirmed under the penalties of perjury.”¹ That is not decorative. A parent who knowingly signs a false statement can be prosecuted for perjury.

No clergy letter is required, and the exemption is not limited to members of organized religions. The belief does have to be religious, though. Personal, philosophical, or political objections to vaccination do not qualify. Schools rarely investigate the sincerity of a stated belief, but the perjury affirmation is the legal check the statute uses in place of an inquiry.

The religious exemption also has a built-in limit: it applies only “in the absence of an epidemic or immediate threat of an epidemic.”¹ During an active outbreak, the exemption effectively pauses.

COVID-19 Is Not on the Required List

Parents often ask how to file an exemption for the COVID-19 vaccine. In Tennessee, no exemption is needed. State law expressly excludes any immunization for the SARS-CoV-2 virus or its variants from the school immunization requirement, so schools and child care facilities cannot require a COVID-19 vaccination as a condition of attendance.¹

What an Exemption Does Not Do During an Outbreak

An approved exemption does not guarantee continuous school attendance. When there is an epidemic or the immediate threat of one, schools identify students with exemptions as susceptible and can exclude them. The Tennessee Department of Health’s measles guidance, for instance, directs schools to exclude exposed children and staff who lack proof of immunity for up to 21 days after the last exposure, and potentially up to 28 days if immunoglobulin was given as post-exposure treatment.³

Families relying on a religious exemption should plan for that possibility. An exclusion can run several weeks, and the school is not required to provide alternative instruction during it. A student returns after showing proof of immunity, either through vaccination or lab evidence of prior infection.

Denial and Revocation

Neither exemption is automatic. Schools review medical submissions for completeness, and documentation that lacks a physician’s signature, omits the specific medical condition, or fails to link the condition to a particular vaccine can be rejected. A religious statement that on its face describes philosophical or political objections rather than religious tenets can also be turned down, though schools generally do not conduct deep sincerity inquiries.

An approved exemption can also lose its footing later. A medical exemption can be revoked if the underlying condition resolves or the certifying physician withdraws the certification. A religious exemption is suspended by operation of the statute during an epidemic or immediate threat of one. Tennessee law also requires that any school communication about immunization requirements inform families of the available exemption grounds.¹

Tennessee has no formal administrative appeal route for a denied school exemption. If a medical exemption is rejected, the practical first step is to have the physician revise the certification so it meets the statute’s requirements. If a religious exemption is denied on grounds that appear to challenge the legitimacy of a genuinely held religious belief rather than the format of the statement, consulting an attorney familiar with Tennessee education law is the next reasonable step.

Penalties for False Exemption Claims

Tennessee treats fraudulent exemptions seriously, and the penalty depends on what was faked.

False Religious Statements

Because the religious exemption statement is affirmed under penalty of perjury, a parent who knowingly signs a false one is exposed to prosecution under Tennessee’s perjury statute. Perjury is a Class A misdemeanor, punishable by up to 11 months and 29 days in jail, a fine of up to $2,500, or both.⁴⁵ Actual prosecutions are uncommon, but the framework is clearly on the books.

Forged Medical Documentation

Submitting a fabricated physician’s certification is more serious. Tennessee law makes it a Class E felony to knowingly create a false entry in a governmental record, present a falsified document as genuine, or intentionally destroy or alter such records, and a forged medical exemption filed with a public school can fall within that provision.

Federal charges may layer on when the fraud involves government seals or documents. Using or possessing a document bearing a fraudulently affixed government seal is punishable by up to five years in federal prison.⁶ Beyond criminal exposure, a student found to have a fraudulent exemption can be removed from enrollment, and schools can report suspected fraud to state health officials.

Workplace Vaccine Exemptions

The school statute does not reach workplaces. Employees who need to be excused from a workplace vaccination requirement rely on federal law: Title VII of the Civil Rights Act for sincerely held religious beliefs, and the Americans with Disabilities Act for medical reasons. Tennessee’s own Human Rights Act also prohibits religious discrimination in employment.⁷

Religious Accommodation

Title VII requires employers to reasonably accommodate a sincerely held religious belief unless doing so would impose an undue hardship on the business. Employers should generally assume a request is sincere; a limited factual inquiry is appropriate only when there is an objective reason to doubt sincerity, such as past behavior clearly inconsistent with the stated belief. Religious beliefs can also evolve, so an employer cannot reject a request simply because the employee did not previously observe the belief.⁸

Medical Accommodation

An employee who cannot receive a vaccine because of a disability is protected under the ADA. The process starts when the employee tells the employer that an exemption is needed. From there, the employer and employee work through what federal guidance calls an “interactive process” to find a reasonable accommodation, which can include masking, distancing, modified shifts, periodic testing, telework, or reassignment. The employer can request medical documentation of the disability and the reason it prevents vaccination, but only if the need is not already apparent.⁹

Even where an unvaccinated employee is said to pose a “direct threat” to workplace health or safety, an employer cannot terminate without first considering whether a reasonable accommodation would reduce or eliminate the risk. That threat determination must be individualized and grounded in current medical evidence, not generalized concern.⁹ Denying a request without engaging in the interactive process is where employers most often run into legal trouble.

Filing a Complaint

An employee who believes an exemption request was mishandled has 300 calendar days to file a discrimination charge with the EEOC in Tennessee, because the state has its own fair-employment agency; the baseline federal deadline is 180 days.¹⁰⁷ Internal grievance procedures do not pause the clock.

1
Justia. Tennessee Code 49-6-5001 – General Provisions
2
Tennessee Department of Health. Immunization Requirements
3
Tennessee Department of Health. Measles Guidance for Schools
4
Justia. Tennessee Code 39-16-702 – Perjury
5
Justia. Tennessee Code 40-35-111 – Authorized Terms of Imprisonment and Fines
6
Office of the Law Revision Counsel. 18 U.S. Code 1017 – Government Seals Wrongfully Used and Instruments Wrongfully Sealed
7
Tennessee Human Rights Commission. Understanding the Tennessee Human Rights Commission
8
U.S. Equal Employment Opportunity Commission. Religious Discrimination
9
U.S. Equal Employment Opportunity Commission. What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws
10
U.S. Equal Employment Opportunity Commission. Time Limits For Filing A Charge