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Sample Letter of Assistance
May 21, 2002
Robert Williams Family
1829 Center St
Silver Lake, IN 46510

To Whom It May Concern:

We are writing to you at the request of the Williams family who would like to participate in activities with your organization, but was informed they may be restricted because of an immunization issue.
The Christian Health Fellowship is an organization of Christians dedicated to the maintenance and restoration of health through adherence to Scriptural principles. We subscribe to certain beliefs about God, Man, and Health. We believe that submitting ourselves or our children to immunizations would violate our religious beliefs and would therefore hinder our service and/or worship of our Creator.

The Williams family are active members in good standing with the Christian Health Fellowship. By use of this letter, they object in writing that the administration of immunizing agents conflict with their religious tenets or practices.

Indiana Law states
IC 20-8.1-7-2
Sec. 2. (a) Except as otherwise provided, a school child may not be required to undergo any testing, examination, immunization, or treatment required under this chapter when the child's parent objects on religious grounds. A religious objection does not exempt a child from any testing, examination, immunization, or treatment required under this chapter unless the objection is:
(1) made in writing;
(2) signed by the child's parent; and
(3) delivered to the child's teacher or to the individual who might order a test, an exam, an immunization, or a treatment absent the objection.

The Williams family’s wish to fully comply with the law and have therefore fulfilled all 3 parts of this statute by:
(1) using this letter as written religious objection
(2) signing below as the child’s parent; and
(3) delivering this letter to the individual that requested the immunization records to be completed.

The Christian Health Fellowship wishes to thank you for your attention to this matter.


Jennifer Fletcher

Christian Health Fellowship Administrator

{Member Signature ______________________________ Date




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