AFFIDAVIT OF RELIGIOUS OBJECTION TO IMMUNIZATION
[Name of parent or legal guardian] personally appeared before the undersigned notary public and swore or affirmed as follows:
This ____ day of ____________, ________.
___________________________________
Parent or Legal Guardian
Sworn and subscribed before me this ___ day of ________________, ______.
___________________________________
Notary Public
My commission expires _______________.
Ga. Comp. R. & Regs. R. 511-2-2-.07
O.C.G.A. §§ 20-2-771, 31-2A-6, 31-12-3, 49-5-12.