"The Health Department does not get involved with that process at all," Medical Director at the Idaho Department of Health and Welfare Dr. Christine Hahn said, "That's when they go to register the child for school, they can fill out an exemption form."
On the form, parents will find two options: "Medical Exemption", requiring a signature of a licensed physician, and "Religious/Other Exemption", signed by a parent.
The medical exemption exists for children who may not be healthy enough to receive the vaccine themselves, and doing so may endanger the health of the child.
The latter allows parents to exempt their children from receiving one or all immunizations based on personal or religious beliefs.
"One of the biggest reasons that my family moved here was because of the ability to choose what you want for your family," chiropractor Dr. Rosie Main said, "and one of the things I love here in Idaho is that we've kept that freedom to choose."
The vaccination process has been in place for decades in the U.S., based on the concept that kids in a school setting can easily share their germs with others.
"They're very close together, they're sitting together in class, they're on the playground together, they're working very closely together, so diseases can potentially spread easily in a school setting," Dr. Hahn said.
But some Idaho parents are concerned about the safety of vaccines and potential side affects. The group Your Freedom Idaho encourages parents to do research at home.
"He had his second two vaccines, Pneumococcal and HiB, when he was five months old, and three days later he started having seizures," Cates said. "My son started becoming developmentally delayed. He didn't receive very many vaccines, but I could tell that they were probably a problem for him and it was kind of my motherly intuition at that point."
Cates stopped vaccinating her son and elected not to vaccinate her second child.
So how common are these exemptions?
Statewide, more than a thousand school-aged children have some sort of immunization exemption on file, but that doesn't mean they haven't received any vaccines.
"A lot of these kids might be vaccinated against other conditions," Dr. Hahn at Idaho Health and Welfare said. "There might just be one condition that the parents have chosen not to give the child."
Some parents who opt out say they're taking a more natural approach to building their child's immunity.
"I was fortunate having my degree in chiropractic, I learned a lot about the immune system," Dr. Main said. "Natural immunity is what we truly believe, that if we allow that Th1 response, which is a cell-mediated response of an immune system, our bodies then develop a warrior system. The more you allow your body to express those symptoms and fight it on its own, you build that warrior system which is your immunity."
But for students in the school system with compromised immune systems, the Health Department says they rely on the students around them.
"In almost every school there are children that can't get certain vaccines because their immune system is weakened, maybe they have cancer, maybe they have another health condition that means they can't safely get vaccinated," Dr. Hahn said. "These children and their families are relying on other kids to hopefully be immunized so they aren't exposed to those diseases."
The nationwide average for children opting out of certain vaccines is 2%, but in Idaho it's about 6.5%. Some of the reasoning behind that, according to the Health Department, is because some vaccines are required in the Gem State that aren't required nationwide.
For the recommended immunization schedule click here.
For more information on Health Freedom Idaho click here.