To whom it may concern:
As (a) parent(s), based on my\our personal religious beliefs, I\we object to the following vaccination , including but not limited to, DTaP\DTP, HepB, Hib, MMR, Polio, Varicella, for my\our child___________________.

The vaccination of my\our child violates laws put forth within me\us by a higher power at the time of conception. Vaccination conflicts with scripture* and my\our spiritual beliefs. Prayer has made me\us realize the responsibility God has bestowed on me\us as (a) parent(s).

*1. Cor. 2:5

Signature/s

Date and keep a copy of the letter.

This is a sample, please use your own words.