In most states, you don't have to belong to a particular church (or any church), but some states require a letter from a "spiritual advisor" confirming that you are sincere about your beliefs. In other states (such as Virginia), you just need to sign a form saying vaccines violate your religious beliefs. Philosophical Exemptions A philosophical exemption is based on a personal belief that doesn't have to be religious. States currently accepting a philosophical exemption are Arizona, California, Colorado, Idaho, Louisiana, Maine, Michigan, Minnesota, New Mexico, North Dakota, Ohio, Oklahoma, Rhode Island, Texas, Utah, Vermont, Washington, and Wisconsin. Some of these states require the parent to sign the form at the local health department in front of a staff member. Proof of Immunity If you can show proof of immunity, you may be able to get an exemption. This requires submitting proof that your child has had a particular disease, that he has been vaccinated against the disease, or that his titers show immunity to the disease. Back to my grandson. The same pediatrician who gave Jake a medical exemption offered to test his titers. He had been fully vaccinated between 1 day and 15 months, receiving 30 doses of vaccines. The results of his tests showed that he was still immune to measles, mumps, rubella, diphtheria, tetanus, and hepatitis B more than six years after his last vaccine. My oldest daughter had a different experience. Her pediatrician told her that an insurance company wouldn't pay for titer testing, which