Colorado families claiming a religious or personal-belief exemption from school-required vaccines can get this certificate in two ways: by completing CDPHE's Online Immunization Education Module, with no provider signature, or by having a Colorado-licensed immunizing provider discuss immunizations with them and sign. The provider marks each exempted vaccine and attests that evidence-based information was given and questions were answered.
The parent, guardian, or adult or emancipated student completes student and school details and signs the exemption statement. Under Option 2, a Colorado-licensed MD, DO, APN, PA, RN or pharmacist marks the vaccines, signs the attestation and gives a Colorado license number.
Download the current version from the source each time; forms change without notice.
Certificate of Nonmedical Exemption
Certificado de Exención No Médica
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No. C.R.S. 25-4-903 does not require providers to sign. Families can instead complete CDPHE's Online Immunization Education Module, which produces a certificate without any provider signature. A provider who chooses to sign under Option 2 attests to an immunization discussion.
That they discussed immunizations with the student, if emancipated, or with the parent or guardian, who received evidence-based, accurate vaccine information and had their questions answered, and that the form is complete and accurate. The signer gives name, title and Colorado license number.
It depends on the setting. K-12 certificates expire each June 30, camps need one dated within 12 months, colleges need one at each enrollment, and preschool or child care certificates are renewed at each immunization interval until kindergarten.