Religious Exemption Form

Copy/paste of the exemption file.

Religious Exemption Form

I, ________________________ am requesting a religious exemption to the Covid-19 vaccine based on my sincerely held religious beliefs. This is my Constitutional and civil right afforded to me by the US Constitution and Indiana law. Any denial of such would be a discriminatory act against my right to freedom of religion.
I seek to go further into detail as to why receiving the covid shot conflicts with my sincerely held religious beliefs.
I believe in God, and that God has created us in His image. In being
created in God’s image, we are given his perfect immune system. We are
bestowed with His gift, the immune system. I believe it is sacrilegious and
a violation of my sacred religious beliefs to violate what God has given us
by showing a lack of faith in God. Immunizations are a lack of faith in God
and His way, the immune system. I believe that receiving immunizations shows
God that I have no faith in His promises of protection for us, saying that I
trust man more than His holy words of protection for us. I believe in
Jesus, and his many promises of protection for us if we place our trust in
My religious beliefs are also based upon the understanding of what God
requires of them as provided for in the Bible.
1 Corinthians 8:6
Yet for us there is one God, the Father, from whom are all things and for
whom we exist, and one Lord, Jesus Christ, through whom are all things and
through whom we exist.
2 Corinthians 6:16-7:1
For we are the temple of the living God; and God said, “I will live in them
and move among them, and I will be their God, and they shall be my people.
Therefore come out from them and be separate from them, and be separate from
them, says the Lord, and touch nothing unclean; and I will welcome you, and
I will be a father to you, and you shall be my sons and daughters, says the
Almighty.” Since we have these promises, beloved, let us cleanse ourselves
from every defilement of body and spirit, and make holiness perfect in the
fear of God. Romans 14:14
I know and am persuaded in the Lord Jesus that nothing is unclean in itself;
but it is unclean for anyone who thinks it unclean. 1 Corinthians 12:24-27
But God has adjusted the body, giving the greater honor to the inferior
part, that there may be not discord in the body, but that the members may
have the same care for one another. If one member suffers, all suffer
together; if one member is honored, all rejoice together. Now you are in the
body of Christ and individually members of it.
1 Corinthians 11:29-30
For anyone who eats and drinks without discerning the body eats and drinks
judgement upon himself. That is why many of you are weak and ill, and some
of you have died.
Mark 2:17
And hearing this, Jesus said to them, “It is not those who are healthy who
need a physician, but those who are sick; I did not come to call the
righteous, but sinners.”
Mark 10:26-28
And they were exceedingly astonished, and said to him “Then who can be
saved?” Jesus looked at them and said, “With men it is impossible, but not
with God; for all things are possible with God.”
1 Corinthians 2:5
That your faith should not stand in the wisdom of men, but in the power of
Mark 5:34
And he said to her, “Daughter, your faith has made you well; go in peace and
be healed of your disease.”
Ephesians 2:8-10
For by grace you have been saved through faith; and this is not your own
doing, it is the gift of God – not because of works, lest any man should
boast. For we are His workmanship, created in Christ Jesus for goods works,
which God prepared beforehand, that we should walk in them.
Psalms 91:11
For he will give his angels charge of you to guard you in all your ways.
Isaiah 58:11
And the Lord will guide you continually, and satisfy your desire with good
things, and make your bones strong; and you shall be like a watered garden,
like a spring of water, whose waters fail not.
My belief in God dictates that I do not consent to the Covid-19 vaccine or any invasive testing as consequence to this decision.
Thank you,



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