(Insert Date)


(Address to your local Board of Education)


§3313.671 - Required Immunizations; Exceptions

B.4 – A pupil who presents a written statement of the pupil’s parent or guardian in which the parent or guardian objects to the immunization for good cause, including religious convictions, is not required to be immunized.



To Whom It May Concern:

          After listening to many debates; reading a variety of articles, facts, and personal accounts; and personally interviewing numerous authorities on either side of the vaccine issue, I have decided that vaccines are not in the best interest of my child, _______________________.



Thank you,



(sign here)