Update to the Conscientious Exemption Affidavit Form

The paper that is currently being used to print the affidavit for exemptions from immunizations for reasons of conscience has changed.  A childcare facility or school should accept a valid vaccine exemption affidavit that is printed on either the new or old affidavit paper. Conscientious exemption affidavits printed on both types of paper are valid for two years from the date notarized.  

The text and formatting of the affidavit is exactly the same between the old and new affidavit forms: 

• Number in upper right corner in red ink 
• DSHS logo in upper left corner 
• State seal water mark 
• Color of paper is light blue, but slightly different tint 
• When copied, the copy will show the word “void” 
• Blank back page, but when held to the light the repeated words “Kan’t Kopy” appear

There are some differences between the old and new paper: 

If you have any concerns about the validity of an exemption affidavit form, please contact DSHS at SchoolImm@dshs.texas.gov.  

View additional news and updates related to Texas School & Child-Care Facility Immunization Requirements