• On August 18th, 2021, Governor Inslee under state of emergency authority directed all K-12 employees to be fully vaccinated by October 18th, 2021, as a term of employment. This means an employee’s final vaccine shot must be received no later than October 4th, 2021.

    Contained within the Governor Inslee’s directive was the option for staff to request either a medical or religious exemption. This form is a request by the following employee for one of these two exemptions. This completed form and the required attachment should be presented at the individual meeting for an interactive process which is scheduled for that employee at their school or district worksite.

    All employees shall note that falsified information may result in disciplinary action, up to and including termination of employment.

    Please do not send your forms into the district office, you will provide your paperwork during your scheduled individual meeting with Human Resources.


    Vaccine Exemption Form


    August 27, 2021

Last Modified on August 27, 2021