Official Code of Georgia Annotated
TITLE 20. EDUCATION
CHAPTER 2. ELEMENTARY AND SECONDARY EDUCATION
ARTICLE 16. STUDENTS
PART 3. HEALTH
OCGA § 20-2-771 (2007)
§ 20-2-771. Immunization of students ….
(b) No child shall be admitted to or attend any school or facility in this state unless the child shall first have submitted a certificate of immunization to the responsible official of the school or facility ….
(e) This Code section shall not apply to a child whose parent or legal guardian objects to immunization of the child on the grounds that the immunization conflicts with the religious beliefs of the parent or guardian; however, the immunization may be required in cases when such disease is in epidemic stages. For a child to be exempt from immunization on religious grounds, the parent or guardian must first furnish the responsible official of the school or facility an affidavit in which the parent or guardian swears or affirms that the immunization required conflicts with the religious beliefs of the parent or guardian….
Whereas, the undersigned named person herein affirms that the same is the parent or legal guardian of the same child person also named below; and
Whereas, as this same parent or legal guardian objects to immunization of this same child; and
Whereas, such same objection has grounds in the private religious beliefs of the same parent or guardian; and
Whereas, for a child to be exempt from immunization on religious grounds, the parent or guardian are asked to furnish an affidavit to the responsible official of the school or facility; and
Whereas, such affidavit be one in which the parent or guardian swears or affirms that the immunization required would conflict with the religious beliefs of the parent or guardian; and
Whereas, such beliefs may be private conscientious religion convictions not shared with others in the community; and
Whereas, such beliefs or convictions shall be kept personal and private and not shared publically; and
Now Therefore, for all these and any other necessary good and lawful reasons, the undersigned adult person named hereby swears or affirms for all lawfully to obtain an exemption from immunization on religious grounds OCGA § 20-2-771(e).
Signature Day / Month / Year
____________________________________ …… for the child: ______________________________
Printed Name of Parent or Guardian Printed Name of Child
The above named individual appeared personally before me, and having established their identity to my complete and total satisfaction set their hand before me and signed the same:
My Commission expires: ___________________________
Day / Month / Year