Health Department Waiver Rule Feedback

Your Contact Information

Name

This address will receive a confirmation email

School Experience

School District

Did the school(s) inform you of your right to opt out of vaccination?

Yes No

Did you have trouble getting the school to accept your vaccine waiver?

Yes No TBD/haven't turned in yet

Please explain if you had trouble turning in your child's vaccine waiver.

Did you feel your waiver was accepted with professionalism and without bias?

Yes No

Health Department Experience

Did you receive the waiver?

Yes No

Name of the nurse who assisted you (f you cannot remember, state "unsure")

Please describe the experience

Did they need to involve their supervisor or another member of the HD staff?

Yes No

Overall the experience went:

As good as can be expected Neither good nor bad Did not go well

Were you able to freely indicate your objection?

Yes No

Which type of objection did you state?

Philosophical Religious Both Other

If you chose other, please explain:

If you sought a religious waiver, did you experience any of the following? Inability to get one Was told your religious views are invalid Was questioned about your religion Was discouraged to select religious Had a philosophical exemption granted despite claiming religious

What general concerns do you have related to the rule?

Discriminatory Education Provided is Biased Harassment Inconvenient/Waste of Time Language/Signing the Health Dept Waiver Other

If you chose other, please explain:

Advice to fellow parents (optional)

Is there any advice you'd like to offer to parents? This information would be used in creating a tip sheet or updating our website at michiganvaccinechoice.org/school-waivers. Your name would not be shared or referenced with this advice.

Description

Michigan for Vaccine Choice is seeking feedback on the Health Department Waiver Rule. Knowing how this rule impacts you and your family is important to share with legislators. While we collect your name and contact information, that information is NOT shared. We only compile the school and waiver experience feedback. If you have any questions or concerns, please send an email to info@michiganvaccinechoice.org.

Health Department Waiver Rule Feedback

Description

Please Fix the Following