Template for Religious Mask Exemption Request

Template for Religious Mask Exemption Request






To _______________________________________________,

In that I am a member of the Church ________________________________________, I am exercising my right to receive a religious exemption for the wearing of a mask or any such device as defined by the FDA under the EUA. Should I become symptomatic, I will quarantine as is customary per sick protocol.

The scriptures are very specific about how those who practice Christianity should navigate life.  Ephesians 6:10-18 directs us to “put on the armor of God,” so that we can be equipped with truth, righteousness, peace, and faith.  We are taught not to be afraid and that we have divine protection. There is zero science which supports masks as safe for prolonged use or effective in preventing the spread of or protection from infection. However, there is significant evidence that masks are a hazard to my health and therefore pose a danger. Hence, I am not afraid, and it is my belief that God will indeed protect me from infection and a mask will not.

Given the above information and the fact that there have been zero documented cases of asymptomatic spread in the world for COVID-19 since the start of the pandemic, requiring healthy individuals to wear a mask for prolonged periods of time, indoors, outdoors, and while exercising is the definition of ludicrous. I, therefore, will trust the wisdom given to me by God to direct my life and choose to believe His will for my life is that I should not subject the temple, my body, where He resides to such unfounded and dangerous medical practices. (Proverbs 3:5-6, Proverbs 23:18)

According to the Section 564 of the Federal Food, Drug, and Cosmetic Act, a lawful application of the terms of a lawful emergency use authorization (“EUA”) pursuant includes the right of informed consent and the option to refuse[1]. The FDA’s guidance on the right to “informed consent” and the option “to refuse”, highlights the right of informed consent and the option to refuse governing the administration of Emergency authorized “unapproved products.” Masks are currently under EUA and therefore the right to refuse(exemption) must be allowed by federal law. To not allow for the option of refusal is clearly breaking federal law and the civil liberties afforded under the 14th amendment. https://www.fda.gov/vaccines-blood-biologics/vaccines/emergency-use-authorization-vaccines-explained

Therefore, as a faithful Christian (and under Federal law and the 14th amd.), I have the right to an objection of conscience regarding what is put on my child’s body to include the medical device as defined by the FDA as a mask.

The use of masks is a violation of my faith and my children’s faith to adhere to moral conscience and divine direction, therefore, under the teachings I follow, I am religiously and morally bound to submit this exemption for the wearing of masks. This exemption is to be made effective immediately upon the receipt of this letter for (put your kids names here).

I would greatly appreciate your prompt written acknowledgement of my concerns upon receipt of this letter, and the assurance that my personal medical choices will not negatively impact my children’s education. Please also affirm the named individual(s) above will not face any retaliatory disciplinary action regarding my choice to evoke religious exemption on their behalf which is my right as their parent or pressure by any school personnel to follow these mandates.  Further, this exemption is confidential and therefore shall not be shared with any other individuals outside of what is necessary.

It should also be understood that you are to speak directly with me in regard to this exemption and not the named individual(s) above at any time.


Thank you for your time.










(Please see attached US code below)


Section 564 of the Federal Food, Drug, and Cosmetic Act 21 US code 360bbb-3 of Authorization for medical products for use in emergencies mask use must meet specific requirements. By law, all the following requirements must be met if any person or organization (school system) is to impose any medicine or medical procedure/device on the public.

that the current mandate’s potential benefits outweigh the known and potential risks of the product which is a requirement which must be met for EUA use as stated in section (B):

(B) the known and potential benefits of the product, when used to diagnose, prevent, or treat such disease or condition, outweigh the known and potential risks of the product, taking into consideration the material threat posed by the agent or agents identified in a declaration under subsection (b)(1)(D), if applicable;

(A) Required conditions:

“(ii) Appropriate conditions designed to ensure that individuals to whom the product is administered are informed-

(I) that the Secretary has authorized the emergency use of the product;

(II) of the significant known and potential benefits and risks of such use, and of the extent to which such benefits and risks are unknown; and

(III) of the option to accept or refuse administration of the product, of the consequences, if any, of refusing administration of the product, and of the alternatives to the product that are available and of their benefits

and risks.”

[1] 21 USCS § 360bbb-3


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