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Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. oF=l#MsX!/M{au!P?kI>'1mn' w0 hb```"#AW! !R`bF5A bd; Unvaccinated children can infect people of any age who can't be immunized for medical reasons. %%EOF Now you can print, download, or share the document. Certification: If so, please explain how. To begin the form, use the Fill camp; Sign Online button or tick the preview image of the form. Take as long time as you need if you feel rusty. endstream endobj 1073 0 obj <>/Metadata 18 0 R/Pages 1070 0 R/StructTreeRoot 60 0 R/Type/Catalog>> endobj 1074 0 obj <>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 1075 0 obj <>stream rpIUmZ dM-Zp I acknowledge that I am aware of the following: the United States since the pandemic started. Medical exemptions must include documentation from a licensed healthcare provider that demonstrates the exemption applies to the specific individual submitting the certification because the COVID-19 vaccine is medically contraindicated for 2 the individual. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. PHILOSOPHICAL/STRONG MORAL OR ETHICAL CONVICTION EXEMPTION State your reason for requesting this exemption. 2. Open the email you received with the documents that need signing. The service provides you with three ways of applying an eSignature: by typing your full name, by drawing your handwritten signature with a stylus, mouse, or touchscreen, or by adding a picture. Before you accept that letter from your employee's online pastor, it's important to know the facts. stream 234 0 obj <>/Filter/FlateDecode/ID[]/Index[210 51]/Info 209 0 R/Length 114/Prev 140651/Root 211 0 R/Size 261/Type/XRef/W[1 3 1]>>stream Dir% 6 gYQ/6R&Vqwo_(a-w T3H5DX5DUxHzV/+iY`e@: 6zee5:#6:ou@hu@,L:e!H5Y $9SxrSTDuipU-b![}Q*G Exemptions from state or local requirements may apply to some children. Request for a Medical Exception to the COVID-19 Vaccination Requirement Form is for GSA Employee use only.