Pennsylvania Immunization Exemption Forms

This page provides immunization exemption forms for use in Pennsylvania. We are one of the few remaining states that still have religious exemptions, as many have lost theirs over the last few years. Our exemptions for K-12 students are based on Title 28, Chapter 23.84 of the Pennsylvania Code. This is one of the main goals of Health Freedom PA, protecting our existing laws. If you experience any issues using these forms or have additional questions, please use this special email to contact our team:
[email protected]

Remember, you are not ASKING for an exemption, you are EXERCISING your RELIGIOUS RIGHT to exempt out. Change your mindset.

Scroll down for our exemption forms for K-12 Students and Employers/College Students.
Please consider a donation as all of this information has been gathered by our volunteers.

Religious Exemption Form for K-12 Students

Use this form for K-12 public/private PA schools. May also be used for most daycare providers.


Religious Exemption Form for Employers and College Students

This form is based on the United States Constitution as well as the Pennsylvania State Constitution. The Nuremberg Code of 1947 and the Emergency Use Authorization are mentioned, but not required to exercise your rights.


America's Frontline Doctors

AFLDS is looking for college students whose school wants to force them to take the Covid-19 vaccine. If your college is located in California, Colorado, Michigan, New Jersey, New York, or Pennsylvania, please fill out this plaintiff form (there are no “right” answers so please be accurate!) and if your information matches our criteria, our legal team will get in touch with you. 

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America's Frontline Doctors also has a section for the military. The law is clear. An experimental vaccine cannot be mandated. Please edit the portion in red, specific to you, and distribute.

Millions Against Medical Mandates

Millions Against Medical Mandates is a solution-based think tank of organizations and individuals invested in and working for freedom from mandated and coerced medical interventions.

They have plenty of additional resources and information on their website. Click below to visit them. 

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Health Freedom PA, LLC

PO Box 178
Darlington, PA, 16115, US

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