California Vaccine Law: Required Shots, Exemptions, and Appeals

California school vaccine requirements mandate that every child attending a public or private school, preschool, daycare, or childcare center be fully immunized against ten specified diseases before admission. Since 2016, personal belief exemptions have been eliminated. A medical exemption issued by a licensed physician and filed through the state’s electronic system is the only route to enrollment without the required vaccines for children in classroom-based programs.

The Ten Required Vaccines

California Health and Safety Code Section 120335 covers every public and private elementary and secondary school, along with childcare centers, nursery schools, family daycare homes, and development centers.¹ Children must be immunized against:

Diphtheria
Haemophilus influenzae type b (Hib)
Hepatitis B
Measles
Mumps
Pertussis (whooping cough)
Poliomyelitis (polio)
Rubella
Tetanus
Varicella (chickenpox)

The California Department of Public Health (CDPH) can add diseases to this list based on recommendations from the federal Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.¹

The dose count depends on the child’s age. Two checkpoints trigger a full records review: entry into transitional kindergarten or kindergarten, and advancement to seventh grade. One detail worth flagging for parents of rising seventh graders: hepatitis B is not required at that checkpoint, but an age-appropriate pertussis booster is.¹

Conditional Admission While Catching Up

A child who has started the required vaccine series but hasn’t finished can be conditionally admitted. To qualify, the child must have received the first dose of every required vaccine and must not currently be due for another dose at the moment of admission.²

Schools have to review the immunization records of every conditionally admitted student at least every 30 days. At each review the school tells the parent or guardian what doses remain and updates the file. If a child falls behind schedule, the school can exclude them until the next required dose is given.²

Personal Belief Exemptions No Longer Exist

Senate Bill 277 took effect on January 1, 2016, and eliminated personal belief exemptions for every required school and childcare immunization. Philosophical and religious objections both fall under this ban. Parents cannot file a personal belief exemption for any currently required vaccine in California.³

Personal belief exemptions on file before that cutoff were grandfathered, but only until the student crossed into the next grade span. The grade spans are birth through preschool, kindergarten through sixth grade (including transitional kindergarten), and seventh through twelfth grade. Once a grandfathered student entered a new span, the exemption expired.¹ More than a decade after the cutoff, those grandfathered exemptions have largely run out.

Children Who Fall Outside the Requirements

Two narrow groups are not subject to the mandate at all. Students enrolled in a home-based private school and students in an independent study program who receive no classroom-based instruction do not need to show proof of vaccination.¹ The moment those students begin in-person classes, the exemption ends.

Federal law also creates a temporary bypass at enrollment. Under the McKinney-Vento Act, schools must immediately enroll children experiencing homelessness or awaiting foster care placement even when the family cannot produce immunization records. “Immediately” means without delay, generally the same or the following day, and the child must be allowed to attend classes and participate fully while records are obtained.⁴ This is not a permanent exemption. It prevents schools from turning children away at the door while paperwork catches up.

How To Get a Medical Exemption

A medical exemption is the only path to lasting enrollment without full immunization for a child attending in-person school. A licensed physician (M.D. or D.O.) must determine that one or more required immunizations are unsafe for the child based on the child’s physical condition, medical circumstances, or family medical history. The exemption has to specify which vaccines it covers and the probable duration of the medical condition.⁵

Since January 1, 2021, every new medical exemption has to be filed electronically through the California Immunization Registry-Medical Exemption system, known as CAIR-ME. The standardized CAIR-ME form is the only documentation schools can accept for new exemptions. The physician submits the form directly to CDPH’s immunization registry, and the school receives it through that system.⁶ Paper-only exemptions are no longer valid for new filings.

Medical exemptions issued before January 1, 2020, under the older rules stayed in effect until the child reached the next grade span. After that transition point, the child either needs to be vaccinated or have a new exemption filed through CAIR-ME.⁵

State Review and Revocation of Exemptions

California does not simply take medical exemptions at face value. CDPH runs annual reviews of school immunization reports to identify exemptions that need closer scrutiny. A clinically trained CDPH reviewer (physician or registered nurse) must review every medical exemption tied to any of three categories:⁶

Schools with an overall immunization rate below 95%.
Physicians who submitted five or more medical exemptions in a calendar year.
Schools that fail to report vaccination rates to CDPH.

The reviewer checks the exemption against applicable American Academy of Pediatrics criteria and may contact the issuing physician for additional documentation. If the reviewer finds the exemption inappropriate or invalid, the case goes to the State Public Health Officer (or a designated physician), who has authority to revoke it.⁶

A revocation does not pull the child out of school that day. The child can keep attending, but the family has 30 calendar days to begin the immunization schedule required for conditional admission.⁶

Appealing a Revoked Exemption

A parent or guardian can appeal a revoked medical exemption to the Secretary of California Health and Human Services within 30 days of the revocation. The Secretary convenes an independent expert review panel of three licensed physicians with training in primary care or immunization, and the panel evaluates the appeal against CDC, Advisory Committee on Immunization Practices, or AAP guidelines and the relevant standard of care.⁷

The panel’s determination is binding. The Secretary adopts it and issues a written decision, and that decision is not subject to further administrative review. Both the issuing physician and the family can submit information to support the appeal.⁷

Exclusion During a Disease Outbreak

Even a fully compliant student can face temporary exclusion during an outbreak. If there is good cause to believe a child has been exposed to one of the listed diseases and the child’s records do not show immunization against that specific disease, the child may be temporarily excluded until the local health officer determines they are no longer at risk of developing or transmitting the illness.⁵ A medical exemption protects enrollment rights generally, but it does not override outbreak-specific public health measures. Children with valid exemptions can still be sent home during an active outbreak of a disease they aren’t immunized against.

A Note on Colleges

The K-12 statutes described here do not apply to colleges and universities. The University of California and California State University systems each set their own vaccination policies, which often go beyond the K-12 list and, unlike K-12 schools, generally permit exemptions on medical, religious, or disability grounds.⁸ Families of college-bound students should check the specific requirements published by their campus.

1
California Legislative Information. California Health and Safety Code HSC 120335 (2025)
2
Legal Information Institute. California Code of Regulations Title 17 Section 6035 – Conditional Admission
3
California Legislative Information. SB 277 – Public Health Vaccinations
4
National Center for Homeless Education. From the School Office to the Classroom – Strategies for Enrolling and Supporting Students Experiencing Homelessness
5
California Legislative Information. California Health and Safety Code HSC 120370 (2025)
6
California Legislative Information. California Health and Safety Code HSC 120372 (2025)
7
California Health and Human Services Agency. Medical Exemptions Appeal Policy and Procedures
8
University of California. Policy on Vaccination Programs