Colorado Vaccine Exemption Letter: Free Template

We’ve created a simple exemption letter template for anyone who’d like to use it. Please feel free to download and modify to your liking.

An example exemption letter:

Date ___________

A statement prepared for _______________ (name of school, homeschool or family), to be kept confidential as pursuant to the Federal Family Educational Rights Privacy Act (FERPA). This exemption may not be submitted to the Colorado Department of Public Health and Environment (CDPHE) or the Colorado Immunization Information System (CIIS) without my expressed written consent.

This is a statement of vaccine exemption for ______________ (name of student), born on _________ (birthdate), as allowed by Colorado Vaccine Exemption Law, CRS-25-4-903 (2)(b) and as approved by the CDPHE.

Based on my __________ (religious or personal) beliefs, my child will not participate in any or all vaccine programs. I have declined all current and future vaccines for my child including but not limited to:______________________ (list vaccines).


______________ (name of parent or guardian, signed and printed)

_____________ (state relationship with student)

____________ (date signed)

Note on homeschooling:

Homeschoolers in the state of Colorado are required to keep updated immunization records and/or exemption forms or letters on file each year for each student.


It may be helpful to print the letter written by the CDPHE informing schools that the letter of exemption is allowed and the CDPHE form is not required. This letter can be downloaded with the following link: