[DATE]
AFVC-BA
MEMORANDUM FOR Commander, C Company, 1st Battalion, 325th Airborne Infantry Regiment, 2d Brigade Combat Team, 82d Airborne Division, Fort Bragg, North Carolina 28310-5000
SUBJECT: Request for Religious Accommodation for Immunization Exemption
1. I, SPC Johnny A. Smith, (MOS/Branch), hereby request a religious exemption to receiving the Pfizer/Comirnaty COVID-19 vaccine in accordance with AR 600-20.
2. (REMARKS. Soldier MUST include a description of religious tenet or belief contrary to immunization.)
3. As attested on my DA Form 4856, I have been counseled by a primary care manager, or equivalent, on the risks I am taking by not receiving the vaccine. In particular, I have been counseled on specific information about the disease concerned, specific vaccine information including benefits and risks, and potential risks of infection incurred by unimmunized individuals.
4. The point of contact is the undersigned at (910) 555-5556 or johnny.a.smith.mil@mail.mil.
_____________________________
JOHNNY A. SMITH
SPC, USA
Respondent
DEPARTMENT OF THE ARMY
FOXTROT COMPANY, 3-82 GSAB, 82ND CAB
82ND AIRBORNE DIVISION BLDG M 3226 B SERVICE STREET
FORT BRAGG, NORTH CAROLINA 28310-5000
28 September 2021
AFVC-ECF
MEMORANDUM FOR Commander, F Company, 3-82ND GSAB, 82ND CAB, 82ND
Airborne Division, Fort Bragg, North Carolina 28310-5000
SUBJECT: Request for Religious Accommodation for Immunization Exemption
1. I, SPC Tom Brady, (15Q/Aviation), hereby request a religious exemption to receiving the Pfizer/Comirnaty COVID-19 vaccine in accordance with AR 600-20.
2. I believe the immunization is against God's word and that the Army is asking me to commit sin which is against my beliefs.
3. As attested on my DA Form 4856, I have been counseled by a primary care manager, or equivalent, on the risks I am taking by not receiving the vaccine. In particular, I have been counseled on specific information about the disease concerned, specific vaccine information including benefits and risks, and potential risks of infection incurred by unimmunized individuals.
4. The point of contact is the undersigned at (123) 456-6789 or tom.brady.mil@mail.mil.
TOM BRADY, SPC, USA
Respondent
[DATE]
AFVC-B
MEMORANDUM FOR Commander, 82d Airborne Division, Fort Bragg, North Carolina 28310
SUBJECT: Legal Review for SPC Johnny A. Smith's Request for Religious Accommodation for Immunization Exemption
1. BLUF. I reviewed the request for a religious accommodation for a COVID-19 immunization exemption. The packet does/does not comply with all legal and regulatory requirements.
2. Background. The Soldier is assigned to C Company, 1st Battalion, 325th Airborne Infantry Regiment, 2d Brigade Combat Team and submitted a request for a religious accommodation for a COVID-19 immunization exemption.
3. Religious Accommodation Procedures. This religious accommodation packet is complete and meets all requirements specified in AR 600-20 and FRAGO 5 TO HQDA EXORD 225-21 COVID-19 STEADY STATE OPERATIONS.
4. Approval Authority. The Surgeon General is the approval and disapproval authority for this immunization exemption request. You may recommend approval or disapproval.
5. Point of Contact. I may be reached at (910) 555-5555.
ATTORNEY NAME
RNK, JA
Brigade Judge Advocate
