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How do I fill this out?
To fill out the application, start by downloading the form from the Arkansas Department of Health website. Fill in your child's information, and make sure to include the notarized signature of a parent or guardian. Finally, submit the completed application to the Department of Health.
How to fill out the 2023-2024 Immunization Exemption Application?
1
Download the Immunization Exemption Application.
2
Fill out the child's details correctly.
3
Provide a notarized signature from a parent or guardian.
4
Check for completeness before submission.
5
Submit the application to the Arkansas Department of Health.
Who needs the 2023-2024 Immunization Exemption Application?
1
Parents seeking exemptions for their children from vaccinations.
2
Guardians of children enrolled in Arkansas schools.
3
Individuals looking to understand vaccination requirements.
4
Families with religious or personal beliefs against vaccination.
5
Healthcare professionals needing to assist families with exemptions.
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What are the instructions for submitting this form?
Submit your completed Immunization Exemption Application to the Arkansas Department of Health via mail or fax. The physical address for mailing is 4815 West Markham Street, Little Rock, Arkansas, 72205. For fax submissions, use the number (501) 661-2000, and ensure your application includes all required signatures and information to avoid processing delays.
What are the important dates for this form in 2024 and 2025?
Important dates for the 2023-2024 school year include the application submission deadline, which must be submitted each year by the start of school. Exemptions granted will be valid through the summer sessions of 2024. Ensure timely submission to avoid any issues with enrollment.
What is the purpose of this form?
The purpose of the Immunization Exemption Application is to allow parents in Arkansas to formally request vaccination exemptions for their children. This form was established to accommodate families with specific health concerns or beliefs regarding vaccinations. It ensures that all children meet the necessary state requirements while respecting diverse viewpoints.
Tell me about this form and its components and fields line-by-line.
- 1. Child's Name: Full legal name of the child requesting the exemption.
- 2. Date of Birth: The child's birthdate to verify age eligibility.
- 3. Parent/Guardian Name: Name of the parent or guardian filling out the application.
- 4. Contact Information: Phone numbers and email for communication regarding the application.
- 5. Notary Signature: Signature of a notarizing individual to validate the application.
What happens if I fail to submit this form?
Failure to submit the Immunization Exemption Application may lead to your child's exclusion from school or childcare facilities. The lack of a valid application can also mean they are not compliant with state immunization laws, which could result in health risks for your child. It is crucial to ensure the application is accurately completed and submitted.
- Child Exclusion: Unvaccinated children may be barred from attending school during outbreaks.
- Compliance Risks: Failure to submit could result in non-compliance with state vaccination laws.
- Health Risks: Children may be at risk of catching vaccine-preventable diseases.
How do I know when to use this form?
- 1. School Enrollment: For children entering kindergarten or a new school.
- 2. Childcare Registration: When enrolling children in public or private childcare.
- 3. Religious Exemptions: Requested due to personal or religious beliefs.
- 4. Health Concerns: When medical reasons prevent vaccination.
- 5. Multiple Children: For families with more than one child requiring exemptions.
Frequently Asked Questions
How do I download the exemption application?
You can easily download the application form directly from the Arkansas Department of Health's website.
What should I include with my application?
Ensure to include a notarized signature and completed vaccine information statements.
How long does it take to process my application?
Expect an approval or denial letter within ten working days after submission.
Can I fill out the form online?
Yes, you can complete the application digitally before printing it for notarization.
What happens if my application is incomplete?
You will receive a checklist detailing the missing information to complete your application.
How do I submit my application?
Submit your completed application via mail, fax, or email to the Department of Health.
Can I submit for multiple children?
Yes, you must submit an application for each child seeking an exemption.
What educational activity is required?
Parents must review Vaccine Information Statements provided as part of the application packet.
Is there a deadline for submission?
The application must be submitted each school year for that specific academic year.
Who can I contact for questions about my application?
For assistance, call the Immunization Section toll-free at 1-800-574-4040.
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