Covid-19 Vaccine Waiver Form

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Please fill the following form to waive your Covid-19 vaccine requirement for the Florida International Leadership Conference (FILC) 2022.

First & Last Name *

Email and school you are attending with *

If you request an exemption for Medical or Personal reason, please choose a reason below and explain. *

Medical Reason

Personal Reason (Religious, Medical condition, etc)

Other:

Required

Explain *

I have reviewed information from the Center for Disease Control and Prevention website at https://www.cdc.gov/vaccines/vpd/vaccines-diseases.html regarding vaccine preventable disease and related vaccinations and have chosen not to be vaccinated. I understand that if I claim exemption, I must follow all CDC and conference guidelines to maintain safety among myself and others. If I am not 18 years of age or older, my parent or legal guardian must also sign below. Write YES below if you understand and write your full name below to certify your agreement of this exemption form. *

Write your full name for certification of this form *

Submit

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