Volunteer Request for Religious Exemption
Please complete this online Religious Exemption Form by completing all of the questions. This form is only to be used for claiming a religious exemption from the COVID-19 vaccination. If you have any other questions about volunteering in in the Steilacoom Historical School District please contact our volunteer coordinator via email at dballou@steilacoom.k12.wa.us.

The Steilacoom School District will reasonably accommodate the religious practices of its volunteers or prospective volunteers in compliance with federal and state law. However, the District is not obligated to grant an accommodation specifically requested by a volunteer or prospective volunteer in every circumstance.
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Email *
Volunteer First Name *
Volunteer Last Name *
Select Volunteer Location(s) *
Required
I am requesting a Religious exemption from the COVID-19 Vaccination *
Describe the religious belief, practice or observance that is the basis for your request for religious exemption *
Does your religious belief, practice, or observance lead you to object to: *
Briefly explain how your sincerely held religious belief, practice, or observance conflicts with the COVID-19 vaccination requirement. *
I acknowledge and certify that I have read and understand the information provided in this request, and that I have truthfully completed it based on my knowledge, information, and belief. I understand that this form will be stored by the Steilacoom School District. *
Required
If granted a religious exemption I agree to abide by all local and state health guidelines. I agree to wear a mask at all times while volunteering and maintain six foot physical distancing from all individuals (to include students and staff). Failure to adhere to the guidelines will result in immediate termination of your volunteer status with Steilacoom Historical School District.   *
Required
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