Hargrave High School

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School Nurse » Immunization Requirements

Immunization Requirements

Conscientious exemption - (Original affidavit must be provided to the school nurse every 2 years)

A person claiming exclusion for reasons of conscience, including a religious belief, from a required immunization may only obtain the affidavit form by submitting a request (via online form, mail, fax or hand-delivery) to the department. The request must include following information:

  • Full name of child or student
  • Child's or student's date of birth (month/day/year)
  • Complete mailing address, including telephone number
  • Number of requested affidavit forms (not to exceed 5).

View the Request for Exemption from Immunizations for Reasons of Conscience for written requests.

Affidavit form requests will be processed and mailed within one week from the receipt of the request. If additional information is needed in order to process the affidavit, you will be notified.

Email or telephone requests cannot be processed. Requests for affidavit forms must be submitted to the department through one of the following methods:


Obtaining an Affidavit Online

Affidavits may be requested via the Immunization Unit https://www.dshs.texas.gov/immunize/school/pdf/EF11-13140.pdf.


Obtaining an Affidavit By Mail

A written request for an affidavit may be sent through the United States Postal Service (or other commercial carrier) to:

Texas Department of State Health Services
Immunization Branch, Mail Code 1946
P.O. Box 149347
Austin, Texas 78714-9347


Obtaining an Affidavit By Fax

Fax written requests for affidavits to: (512) 776-7544.


Obtaining an Affidavit In Person

NOTE: No requests will be filled at the time of hand-delivery.
All affidavit forms will be mailed to you via U.S. Postal Service.

Requests for an affidavit may be made in-person at:

Texas Department of State Health Services
1100 West 49th Street
Austin, Texas 78756