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Minnesota K-12 Immunization Exemption Form (MDH)

MDH's 'Are Your Kids Ready?' sheet lists Minnesota's K-12 vaccine requirements on page 1, and its reverse side is the form families return to school to document a medical exemption, a non-medical exemption or a history of chickenpox. Each exempted vaccine is marked with an X in the medical or non-medical column.

Who completes it

A licensed physician, nurse practitioner or physician assistant signs the medical exemption, confirming contraindications or lab-confirmed immunity. Parents sign non-medical exemptions before a notary, and chickenpox history is signed by a practitioner, public clinic or parent depending on the date.

Submitting and payment

How to submit it
Return it to the school with the child's immunization record.

Good to know

  • A health care provider must sign chickenpox history if the disease occurred after September 1, 2010; a parent may sign for earlier disease.
  • Unvaccinated children exposed to a vaccine-preventable disease may be kept home from school and activities for up to 21 days.
  • The requirement applies to public, private, online and home schools. The current sheet is ID# 52799, dated 08/2024.
  • Translations include Spanish, Arabic, Hmong, Karen, Somali and Vietnamese, and a separate version covers child care and early childhood programs.

Get the official form

Download the current version from the source each time; forms change without notice.

Are Your Kids Ready? Minnesota K-12 Immunization Law (with medical and non-medical exemption form)

Official pagePDFVersión en español

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Who can sign a Minnesota medical exemption for school?

A licensed physician, nurse practitioner or physician assistant. By signing, the practitioner confirms the child should not receive the marked vaccines for medical reasons (contraindications) or because laboratory testing confirms the child is already immune. Non-medical exemptions are signed by the parent and notarized instead.

Is the Minnesota school exemption form available in Spanish?

Yes. MDH posts a Spanish version along with translations in Arabic, Haitian Creole, Hmong, Karen, Nepali, Oromo, Russian, Somali and Vietnamese. The English version is ID# 52799, dated August 2024, and is linked from MDH's vaccines for children page.