If you are requesting a religious exemption, the explanation portion of the exemption request form needs to be notarized. For a medical exemption request, along with a completed exemption request form, you need to provide documentation from your treating licensed practitioner (e.g. physician, advanced practice provider, CNP) specifying the health-related contraindication, including allergic reaction to an ingredient in a COVID-19 vaccine and/or history of allergic reactions to other vaccines or other medical injections. Documentation must be signed and dated by the licensed practitioner, indicating which COVID-19 vaccine you are not able to receive.