Immunization Forms

Student Immunization Forms

Universal Health Certificate (UHC)

• Used to report a child’s physical health to their school and/or childcare facility.

Religious Immunization Exemption Certificate

• Submit the completed certificate along with a copy of your current government issued ID to DC Health at [email protected].
• DC Law 3-20 requires parents opposed to vaccinations due to religious beliefs to object in good faith and in writing that immunization(s) would violate a sincerely held religious belief.
• This form is valid for one school year (July 1 - June 30).

HPV Vaccination Opt-Out Certificate

• Submit the completed certificate along with a copy of your current government issued ID to DC Health at [email protected].
• The human papillomavirus (HPV) vaccine is a routine immunization recommended for children ages 11-12, and can be initiated as early as age 9, offering protection against certain cancers later in life.
• This form is valid for one school year (July 1 - June 30) and is to be used for sincerely held reasons to delay your child's HPV vaccine.

Translated Documents - Immunization Forms

Adult - Vaccine Exemptions

• The District of Columbia allows for vaccine exemptions in certain situations related to employment requirements administered under DC Health's Human Resources and Labor Administration (HRLA) policies. The HRLA Processing Center can be reached at 877-672-2174.