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