These are to share with Vac Lib to put on the exemption pages there, and also to share with Kenny Valenzuela for his exemption pages at Experimental Vaccines site.
So as I find them, going to start sharing here as well. Only getting the NON incriminating ones.
Share these widely, and even better yet, DOWNLOAD them to your computers, in case they disappear. Sometimes links change, forms are pulled offline, etc..
EDITED: Added South Carolina, Georgia, and Montana, and replaced TWO links from CO, which had changed since this post. Beware of that, it happens, as previously warned.
For the longest time, Oklahoma always had this crappy scanned pdf online form from various sites and we have always wanted a good original one. Well, I finally found the original that the state had finally put up on their website.
[PDF] certificate of exemption - State of Oklahoma
[PDF] certificate of exemption - Epic Charter Schools
I also have current updated links for Maine and Delaware... I've been making groups for each state and adding the non incriminating files in the files section of each state's group. Just added more forms states and links.
Exemptions: Statute 14: 131 (no date available) allows exemption from immunization requirements under the following circumstances: (1) Presentation of a written statement from a physician, i.e., medical doctor or doctor of osteopathy, stating that the student should not receive the prescribed immunizations because of the reasonable certainty of a reaction detrimental to that person (history of clinical illness of measles or rubella not acceptable as cause for exemption), or (2) Presentation of a notarized Affidavit of Religious Belief (outlined in statute) that states that the parents or legal guardians of the student reject the concept of immunization because of individual religious beliefs. In the case of a vaccine preventable epidemic, any child enrolled in school who is exempt from the immunization program shall be temporarily excused from attendance at public school.
AFFIDAVIT OF RELIGIOUS BELIEF
STATE OF DELAWARE
[PDF] affidavit of religious belief - State of Delaware
[PDF] Notarized Affidavit of Religious Belief
[PDF] Affidavit for Religious Exemption from Vaccination Requirement
[PDF] Affidavit for Religious Exemption from Lead Testing Requirement
[PDF] Delaware Religious Belief Affidavit Vaccine Exemption Form
[PDF] Immunization - School Vaccination Medical Exemption Form
[PDF] University of Delaware Immunization and History Form
Maine Religious and Philosophical Belief Exemption Form
IMMUNIZATION EXEMPTION FORM
Maine Regional School Unit 21
Arundel, Kennebunk, Kennebunkport , Maine
Immunization Exemption Form
RSU No. 5
Durham – Freeport - Pownal
Maine Immunization Exemption
Fairfield - Albion - Benton - Clinton
District Medical Immunization Exemption Form
MEDICAL IMMUNIZATION EXEMPTION FORM
Fairfield - Albion - Benton - Clinton
District Medical Philosophical and Religious Immunization Exemption Form
PHILOSOPHICAL/RELIGIOUS IMMUNIZATION EXEMPTION FORM
SCARBOROUGH SCHOOL DEPARTMENT
P. O. BOX 370
SCARBORUGH, ME 04074
IMMUNIZATION EXEMPTION FORM
An annual signed exemption due to religious or philosophical reasons
Exemption Form [DOCX]
University of Southern Maine
If you have not been vaccinated and therefore can not provide proof of immunizations due to moral, political or religious beliefs.
In this case, you may download our "Objection Letter" and submit that in place of the records.
University of Maine at Augusta Vaccine Waiver Form
[DOC] My SMCC - Southern Maine Community College
*WAIVER SECTION* Page 2
[PDF] Immunization Waiver Form - University of Maine at Augusta
Immunization Non-Medical Exemption Form (Religious and Personal Belief)
Immunization Medical Exemption Form
Other Languages Here:
South Carolina Certificate of Religious Exemption (From Immunization)
Religious Exemption form (DHEC form 1126)
[The medical exemption] form is at the bottom of the DHEC 1148
VACCINATION EXEMPTION PURSUANT TO THE
OFFICIAL CODE OF GEORGIA ANNOTATED § 20-2-771
4. (e) This Code section shall not apply to a child whose parent or legal guardian objects to immunization of the child on the grounds that the immunization conflicts with the religious beliefs of the parent or guardian; however, the immunization may be required in cases when such disease is in epidemic stages. For a child to be exempt from immunization on religious grounds, the parent or guardian must first furnish the responsible official of the school or facility an affidavit in which the parent or guardian swears or affirms that the immunization required conflicts with the religious beliefs of the parent or guardian.
ALL GA Vaccine Exemption Affidavits and forms MUST be notarized.
GA Affidavit of Religious Exemption
* Best form, works for any school.
]DOC] Form JGC-4 - Cobb County School District
Atlanta Public Schools:
AFFIDAVIT OF RELIGIOUS OBJECTION
AFFIDAVIT OF RELIGIOUS OBJECTION TO IMMUNIZATION
[PDF] Religious Exemption Form - Dphhs
AFFIDAVIT OF EXEMPTION ON RELIGIOUS GROUNDS FROM MONTANA SCHOOL IMMUNIZATION LAW AND RULES
Note: Above link was just replaced.
Extra Backup links:
[PDF] affidavit of exemption on religious grounds - Experimental Vaccines
BEST Medical Exemption Form because it reads the law on ME's:
HES101_2013 MT Medical Exemption Form.pdf
On Page 2 (SECTION IV EXEMPTIONS)
1. Medical: TO BE SIGNED BY A PHYSICIAN (See Section III, Health Department or Physician)
[PDF] Medical Exemption Form - Dphhs
Medical Exemption Statement
AFFIDAVIT of EXEMPTION FROM ADMINISTRATION of
HAEMOPHILUS INFLUENZAE TYPE b (Hib) on RELIGIOUS
GROUNDS FROM MONTANA
DAYCARE IMMUNIZATION RULES
Experimental Vaccines Link:
Montana Exemption Law
Beware of the language of this current form...
I have been informed that by not receiving this vaccine, my child is at increased risk of developing diphtheria if exposed to this disease . Serious symptoms and effects of this disease include: heart failure, paralysis (can’t move parts of the body), breathing problems, coma, and death
can be edited to this by Crossing out the "not" and change the word "disease" to "vaccine" to read like this...
I have been informed that by receiving this vaccine, my child is at increased risk of developing diphtheria if exposed to this vaccine . Serious symptoms and effects of this vaccine include: heart failure, paralysis (can’t move parts of the body), breathing problems, coma, and death
Because the actual vaccine itself CAN and often DOES CAUSE the so-called risks of the disease, and that is proven by the Tripedia package insert. If the schools give a hard time, then attach a printed copy of the PDF Tripedia Package insert which states these adverse reactions and events.
Tripedia Package Insert Search.
Same editing applies to the Spanish form, as well.
New Incriminating Forms:
Personal Beliefs Exemption:
Formulario de Exención por Creencias Religiosas.pef
Older NON-incrimating Forms:
From the older VacLib archived pages:
Here is the list of the older NON incriminating Arizona forms. Parents can try these instead, but it may depend on the school, whether they will accept the older forms. So please try them, and also download to share with others too.
Daycare & Preschools:
REQUEST FOR EXEMPTION TO IMMUNIZATION CHILD CARE FACILITIES (English and Spanish)
Request for Exemption to Immunization Schools (English and Spanish)
Request for Exemption to Immunization - School (Spanish)
Sequoia Choice - AZ Distance Learning - Mesa, AZ. 85211-1405
If all else fails, and a parent is forced to sign an incriminating form, then write or sign name "Under Duress".
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