Vaccination Exemption Request

To help mitigate the recent surge in COVID-19 and the pressure on our local health care systems, DCM implemented a proof of COVID vaccination requirement effective January 3, 2022.

To seek a medical exemption from this requirement you must provide: A letter from your physician. The letter must provide your physician’s name, address, and phone number. In the letter, the physician must indicate that you have a recognized contraindication for each of the available COVID-19 vaccines or that you have an allergy that precludes you from taking any of the available COVID-19 vaccines.

To seek an exemption on religious grounds: Please submit a letter describing your sincerely held religious beliefs that prevent you from receiving an approved COVID-19 vaccine.

Requests will be reviewed within 72 hours of submission and evaluated on a case-by-case basis. An approval or denial will be sent to the email you provide in this form.

If approved: Bring the letter approving the exemption AND negative COVID-19 test results dated within 24 hours of your Museum visit for the approved individual(s). For a home COVID test, provide a dated photo.

Your Information

Name*

First Last

Email*

Enter Email Confirm Email

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Are you a current DuPage Children's Museum Member?**

Yes

Exemption Request

Which exemption is being requested?**

Medical Exemption

Religious Exemption

For whom is this exemption being requested?**

Myself

My Spouse

My Child(ren)

My Entire Family

Other (please explain relationship below)

Name(s) of those requiring exemption.*

Please upload supporting documentation.* (See requirements at top of page.)

Please upload supporting documentation.* (See requirements at top of page.)*

Accepted file types: jpg, gif, jpeg, png, pdf, heic, Max. file size: 50 MB.

Additional Questions

Questions?

Tell us about your event (Max 500 Characters).

Requests will be reviewed within 72 hours of submission and evaluated on a case-by-case basis. An approval or denial will be sent to the email you provided in this form.