I just took this directly from the Kentucky immunization website. Once again, you signed form in front of notary agreeing to the terms outlined!!!!
Due to my religious beliefs, I object to my child receiving the required immunizations selected above. I am aware that if I change my mind, I can rescind this objection and obtain immunizations for my child. Initials ______________ Additional information about vaccine preventable diseases, immunizations and reduced or no cost immunization services is available from the local health department in each county. To be completed by Notary Public In the event that the county health department or state health department declares an outbreak of a vaccine-preventable disease for which proof of immunity for a child cannot be provided, he or she may not be allowed to attend childcare or school for up to three (3) weeks, or until the risk period ends. STATE OF ) COUNTY OF ) Subscribed, sworn to or affirmed under oath and acknowledged before me, a Notary Public in and for the state and county aforesaid by ________________________, on this the __________ day of _____________________, 20_______. Child’s Name Last First Middle Child’s Date of Birth MM/DD/YYYY