Use this form to provide immunization information to your school district with your statement of intent. You can also use this form to opt out of immunizations by choosing the correct exemption code (at the bottom of the form) and plugging it into the correct immunization row. You are required by law to provide this information to your school district with your statement of intent. If you do not have changes from year to year, and you are submitting the statement of intent to the same school district, check the line that says your child's record is on file at the school and nothing has changed.