Covid 19 Information & Exemption Forms


In Compliance with Executive Order 13G and DPH Implementation Guidance


In accordance with Executive Order 13G, the Middletown Public Schools (the “District”) requires each prospective employee to demonstrate that the individual

1.      is fully vaccinated against COVID-19,

2.      has received the first dose and has either received a second dose or has an appointment for the second dose in a two-dose series vaccination, such as Pfizer or Moderna vaccines, or has received a single-dose vaccine, such as Johnson & Johnson’s Janssen vaccine, or

3.      is exempt from this requirement because a physician, physician’s assistant, or advanced practice registered nurse determined that the administration of COVID-19 vaccine is likely to be detrimental to the covered worker’s health, or the individual objects to vaccination on the basis of a sincerely held religious or spiritual belief, and the covered worker is able to perform their essential job functions with a reasonable accommodation that is not an undue burden on the district.


In accordance with Executive Order 13G and the District’s COVID-19 Vaccination Regulations, the District will request that prospective employees provide adequate proof of their vaccination status or request a medical or religious exemption [at an appropriate time OR when notifying employees that they have been selected for an interview OR at another time determined by the District].  Requests for a medical or religious exemption will be considered on an individualized, case-by-case basis. 


Pursuant to Executive Order 13G, the District is prohibited from extending an offer of employment to any applicant who does not provide adequate proof of COVID-19 vaccination or demonstrate, in a manner determined by the District and in accordance with Executive Order 13G, that they are exempt from this requirement for medical or religious reasons.


In addition, upon hiring, any covered worker who is not fully vaccinated due to medical or religious exemptions must submit to weekly COVID-19 testing and provide adequate proof of negative test results to the District on a weekly basis, in accordance with District regulationsand may be required to comply with additional health and safety protocols, as determined by the District.


For more information, including information about how to provide adequate proof of vaccination or submit a request for a medical or religious exemption from the COVID-19 vaccination requirement, please carefully review the District’s COVID-19 Vaccination Regulations, available at  

Medical Exemption Form

Religious Exemption Form