Daycare vaccine requirements by state.

Every US state requires children in licensed daycare to be vaccinated against a core set of diseases. The base schedule is set federally by the CDC's Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics; the legal force comes from each state's child care licensing law. What changes state to state is which exemptions are allowed (medical only, or also religious or philosophical), how strictly the rules are enforced at enrollment, and which vaccines beyond the core list are required.

This guide walks through what the 2026 daycare vaccine landscape actually looks like: the standard required schedule, the meaningful state-by-state differences, how exemptions work, and what you should expect to hand the daycare director at enrollment.

The base schedule daycares require

Almost every state child care licensing law requires children to be up to date on the ACIP-recommended schedule. By the time a child is 18 months old, that schedule includes the vaccines below.

By the time a child enters kindergarten, additional booster doses are required (a second MMR, a second varicella, a DTaP booster). Annual flu vaccination is recommended for everyone six months and older.

A handful of states also list COVID and RSV (for high-risk infants) in their child care recommendations, but neither is required for daycare attendance in any state as of May 2026. For the broader context, see our piece on COVID at daycare in 2026.

What documentation the daycare actually wants

When you enroll, the director will ask for one of two documents.

• An immunization record from your pediatrician. Most pediatric offices print this on a standard state form or pull it from the state immunization registry. Some hand it to you at every well-child visit; some let you download it from a patient portal.
• A state-issued certificate of immunization. Many states (including California, New York, and Texas) have an official form that pediatricians fill out and parents bring to enrollment.

The daycare director keeps this on file. They will also typically ask for an updated copy after every well-child visit. If your child is between doses (for example, has had two of the three required IPV doses), most states allow conditional enrollment with a timeline for the remaining doses.

Exemptions: medical, religious, philosophical

Every state allows at least one type of vaccine exemption. The distinctions are important.

Medical exemption. Allowed in all 50 states. Requires documentation from a licensed physician that a vaccine is contraindicated for the specific child. The most common reasons are severe allergic reaction to a previous dose, certain immunocompromised conditions, or a documented adverse reaction. Medical exemptions are rare.

Religious exemption. Allowed in most states, but not all. As of May 2026, the following five states do not allow religious exemptions for child care or school: California, Connecticut, Maine, Mississippi, New York, and West Virginia. In those states, only medical exemptions are accepted. Documentation requirements for religious exemptions vary widely; some states accept a signed parental statement, others require a notarized affidavit.

Philosophical or personal-belief exemption. Allowed in roughly 15 states as of 2026. The list shifts as legislatures revisit the policy after measles outbreaks. NCSL maintains a current tracker. Where philosophical exemptions are allowed, they typically require a signed parent statement and, increasingly, an education module or a counseling session with a public health officer.

A state-by-state summary

The table below summarizes exemption allowances. The "Required" column does not vary much across states, because all 50 require the core ACIP schedule. What varies is the exemption regime and the influenza requirement.

This is a snapshot, not a legal source. Always confirm with your state's health department or your daycare's licensing handbook before relying on it. The CDC's "State Vaccination Requirements" portal links out to each state's official policy.

What enrollment actually looks like

In practice, vaccine documentation is one of two or three things that has to be in the file before a child's first day. The other documents typically include a current physical (often within the last 12 months), emergency contact forms, and a feeding or allergy plan if relevant (see our piece on daycare food allergy plans).

A few enrollment patterns to expect:

• Conditional enrollment is common. If your child is on schedule but has not yet received a specific dose, most states allow a 30 to 60 day grace period to complete it. The director will note the next-dose deadline in the file.
• Up-to-date records are checked at every milestone. Many centers ask for an updated immunization record after every well-child visit (typically 2, 4, 6, 9, 12, 15, 18 months and then annually).
• Exemption paperwork goes in the same file. If your child has a medical, religious, or philosophical exemption, the daycare keeps that documentation alongside the immunization record. State licensing inspectors will check both.
• Refusal of an unvaccinated child is legal in some states. Even where a religious exemption is allowed at the state level, individual daycare centers are allowed in many states to refuse enrollment to unvaccinated children. This is a private-business decision, not a public-health one. Our piece on unvaccinated children at daycare covers this nuance.

What happens during an outbreak

If a vaccine-preventable disease (measles, pertussis, mumps) is reported at a daycare, state health departments have the authority to order the temporary exclusion of unvaccinated children and unvaccinated staff for the duration of the outbreak window (typically 21 days for measles, longer for pertussis). This applies even to children with valid religious or philosophical exemptions. The rationale is straightforward: an exemption is a private right, not a public-health override.

During an outbreak, your daycare will work with the local health department to send notifications and coordinate testing. If you are choosing a daycare in a city with a recent outbreak history (for example, certain Brooklyn neighborhoods during the 2018-2019 measles outbreak), it is worth asking the director how they have handled outbreak windows in the past.

Bottom line

Daycare vaccine requirements are mostly federal at the level of the schedule, mostly state at the level of exemptions, and mostly handbook at the level of how strictly a specific center enforces them. Bring a current immunization record (or your state's certificate of immunization) to enrollment, expect updates after every well-child visit, and read your state's exemption rules carefully if your family is not following the ACIP schedule. For the broader picture of how daycares think about safety and licensing, our quality and safety pillar ties this article into the larger framework.