Request for Immunization Exemption


MEMORANDUM FOR Commander, C Company, 1st Battalion, 325th Airborne Infantry Regiment, 2d Brigade Combat Team, 82d Airborne Division, Fort Bragg, North Carolina 28310-5000

SUBJECT: Request for Religious Accommodation for Immunization Exemption

1. I, SPC Johnny A. Smith, (MOS/Branch), hereby request a religious exemption to receiving the Pfizer/Comirnaty COVID-19 vaccine in accordance with AR 600-20.

2. (REMARKS. Soldier MUST include a description of religious tenet or belief contrary to immunization.)

3. As attested on my DA Form 4856, I have been counseled by a primary care manager, or equivalent, on the risks I am taking by not receiving the vaccine. In particular, I have been counseled on specific information about the disease concerned, specific vaccine information including benefits and risks, and potential risks of infection incurred by unimmunized individuals.

4. The point of contact is the undersigned at (910) 555-5556 or [email protected].


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