Example Exemption Forms

These are examples. They do not represent legal or clinical advice, nor do they represent endorsement by SHEA or the Multisociety Statement’s authors. They should be reviewed by qualified professionals in the organizations where they will be used, and adapted for their needs. 

EXAMPLE Medical Exemptions

  1. EXAMPLE Medical Exemptions for COVID-19 Vaccines (pdf)
  2. UNC Medical Exemption Form (pdf)
  3. Duke Medical Exemption Form (pdf)

EXAMPLE Religious Exemptions

  1. Duke Religious Exemption Form (pdf)
Last updated August 24, 2021