Personal Belief Exemption Form for Childhood Vaccination


New Personal Belief Exemption Form for Childhood Vaccination to Encourage Health Education  


The California Department of Public Health (CDPH) today made available the Personal Belief Exemption (PBE) form parents or guardians are required to use to exempt their children from childhood vaccinations as required by a new state law that takes effect January 1, 2014.

The PBE form must be signed by both a health care professional and a parent or guardian when seeking an exemption from required vaccinations. The new form also allows for a religious exemption if the family’s religion does not permit members to get medical advice or treatment from a health care practitioner.

“The Department of Public Health encourages parents to get their children vaccinated as it is the best and safest way to prevent many serious, often deadly, diseases in children,” said Dr. Ron Chapman, CDPH director and State health officer. “It is important that parents make an informed decision, and this new form encourages education about vaccinations while protecting an individual’s constitutional rights.”

The form acknowledges that a health care professional has provided information to the parent or guardian regarding the benefits and risks of immunization, including the health risks to the student and the community resulting from declining the recommended immunizations. The health care provider and the parent must each sign the form before the form is turned in to the school. The form also allows for constitutional freedom of religious expression.

All students newly admitted to a California school, kindergarten through 12th grade, students advancing to 7th grade, and children newly admitted to a childcare facility, who wish to be exempt from one or more required immunizations because of their personal beliefs must provide this form to their school or childcare facility.

Children transferring from one grade school in California to another school in California, and not starting kindergarten or the 7th grade for the first time, do not need to provide a new exemption form. Exemptions from the prior schools should be part of the records transferred to the new schools.

The form, information and resources about the Personal Belief Exemption (AB 2109) are available on the CDPH’s Shots for School website, as well as the Parent Resources page of the PVUSD website.


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