I just updated a bunch of links. Now the forms are current.
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Showing posts with label Vaccine Exemption Forms. Show all posts
Showing posts with label Vaccine Exemption Forms. Show all posts
Friday, April 17, 2020
MessiahMews Blogs: New Exemption Forms for Various States
MessiahMews Blogs: New Exemption Forms for Various States: Every now and then, I'll go on a search spree, and find updated and/or new exemption forms online. 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. ...
I just updated a bunch of links. Now the forms are current.
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I just updated a bunch of links. Now the forms are current.
-
Sunday, September 15, 2019
Idaho School Immunization Exemption Forms
Idaho School Immunization Exemption Form
Letter about the positive changes that were made in the ID State Form...
https://s3.amazonaws.com/nursing-network/production/attachments/139831/original/IDHW_School_Imm_Ex_Letter_Feb2018.pdf?2018
* The newer form is no longer incriminating, but fathers and mothers are free to use a different form or letter/statement. However, some schools are still pushing the older incriminating form.
Exemption Forms (generic for any schools):
https://s3.amazonaws.com/nursing-network/production/attachments/139821/original/ID_School_Imm_Ex_Form_Jan2018.pdf?2018
https://healthandwelfare.idaho.gov/Portals/0/Health/Idaho%20Immunizations/Schools/schoolexempform2018.pdf
* CERTIFICADO DE EXENCIÓN DE VACUNACIÓN DE IDAHO [Spanish]
http://healthandwelfare.idaho.gov/Portals/0/Health/Idaho%20Immunizations/Schools/Exemption2017SpanishESMX.pdf
IDAHO CHILDCARE IMMUNIZATION REQUIREMENTS EXEMPTION
https://healthandwelfare.idaho.gov/Portals/0/Health/Idaho%20Immunizations/Childcare/2018Julychildcareexempform.pdf
Middleton School District
5 South Viking Avenue
Middleton, ID 83644
Idaho Certificate of Immunization Exemption (English)
Embedded View:
https://www.msd134.org/Page/1132
Direct Download
https://www.msd134.org//cms/lib/ID01001484/Centricity/Domain/81/School%20exemption%20form%202018%20English.pdf
Idaho Certificate of Immunization Exemption (Spanish)
Embedded View:
https://www.msd134.org/Page/4671
Direct Download:
https://www.msd134.org//cms/lib/ID01001484/Centricity/Domain/81/School%20exemption%20form%202018%20Spanish.pdf
Will add more links to forms, as I find them and will post them.
Beware: Some school districts are still wanting to force the incriminating form.
-
CDC: Idaho has one of lowest vaccination rates in nation for kindergarteners
IDAHO FALLS, Idaho (KIFI/KIDK) - A new report published by the Center for Disease Control shows Idaho has one of the lowest vaccination rates for kindergarteners in the country.
https://www.localnews8.com/health/cdc-idaho-kindergartners-have-one-of-lowest-vaccination-rates-in-nation/808354010
Idaho immunization rates drop — as opt-out numbers surge
https://www.idahoednews.org/news/immunization-rates-drop-as-opt-out-numbers-surge/
Idaho school vaccination exemption rate highest in nation ...
sandpointreader.com › http://sandpointreader.com/idaho-school-vaccination-exemption-rate-highest-in-nation/
Idaho Has High Rate of Students Exempted from Vaccinations ...
https://www.usnews.com/news/healthiest-communities/articles/2018-05-07/idaho-has-high-rate-of-students-exempted-from-vaccinations
Bwuahahaha!
TITLE 39
HEALTH AND SAFETY
CHAPTER 48
IMMUNIZATION
39-4802. EXEMPTIONS. (1) Any minor child whose parent or guardian has submitted to school officials a certificate signed by a physician licensed by the state board of medicine stating that the physical condition of the child is such that all or any of the required immunizations would endanger the life or health of the child shall be exempt from the provisions of this chapter.
(2) Any minor child whose parent or guardian has submitted a signed statement to school officials stating their objections on religious or other grounds shall be exempt from the provisions of this chapter.
History:
[(39-4802) 1978, ch. 240, sec. 1, p. 624; am. and redesignated 1979, ch. 313, sec. 2, p. 846.]
https://legislature.idaho.gov/statutesrules/idstat/title39/t39ch48/sect39-4802/
TITLE 39
HEALTH AND SAFETY
CHAPTER 48
IMMUNIZATION
39-4804. NOTIFICATION TO PARENT OR GUARDIAN. (1) Before an immunization is administered to any child in this state, the parent or guardian of the child shall be notified that:
(a) Immunizations are not mandatory and may be refused on religious or other grounds;
(b) Participation in the immunization registry is voluntary;
(c) The parent or guardian is entitled to an accurate explanation of the complications known to follow such immunization.
.
Letter about the positive changes that were made in the ID State Form...
https://s3.amazonaws.com/nursing-network/production/attachments/139831/original/IDHW_School_Imm_Ex_Letter_Feb2018.pdf?2018
* The newer form is no longer incriminating, but fathers and mothers are free to use a different form or letter/statement. However, some schools are still pushing the older incriminating form.
Exemption Forms (generic for any schools):
https://s3.amazonaws.com/nursing-network/production/attachments/139821/original/ID_School_Imm_Ex_Form_Jan2018.pdf?2018
https://healthandwelfare.idaho.gov/Portals/0/Health/Idaho%20Immunizations/Schools/schoolexempform2018.pdf
* CERTIFICADO DE EXENCIÓN DE VACUNACIÓN DE IDAHO [Spanish]
http://healthandwelfare.idaho.gov/Portals/0/Health/Idaho%20Immunizations/Schools/Exemption2017SpanishESMX.pdf
IDAHO CHILDCARE IMMUNIZATION REQUIREMENTS EXEMPTION
https://healthandwelfare.idaho.gov/Portals/0/Health/Idaho%20Immunizations/Childcare/2018Julychildcareexempform.pdf
Middleton School District
5 South Viking Avenue
Middleton, ID 83644
Idaho Certificate of Immunization Exemption (English)
Embedded View:
https://www.msd134.org/Page/1132
Direct Download
https://www.msd134.org//cms/lib/ID01001484/Centricity/Domain/81/School%20exemption%20form%202018%20English.pdf
Idaho Certificate of Immunization Exemption (Spanish)
Embedded View:
https://www.msd134.org/Page/4671
Direct Download:
https://www.msd134.org//cms/lib/ID01001484/Centricity/Domain/81/School%20exemption%20form%202018%20Spanish.pdf
 |
| Click on open link into a new tab to view full size. |
Will add more links to forms, as I find them and will post them.
Beware: Some school districts are still wanting to force the incriminating form.
-
CDC: Idaho has one of lowest vaccination rates in nation for kindergarteners
IDAHO FALLS, Idaho (KIFI/KIDK) - A new report published by the Center for Disease Control shows Idaho has one of the lowest vaccination rates for kindergarteners in the country.
https://www.localnews8.com/health/cdc-idaho-kindergartners-have-one-of-lowest-vaccination-rates-in-nation/808354010
Idaho immunization rates drop — as opt-out numbers surge
https://www.idahoednews.org/news/immunization-rates-drop-as-opt-out-numbers-surge/
Idaho school vaccination exemption rate highest in nation ...
sandpointreader.com › http://sandpointreader.com/idaho-school-vaccination-exemption-rate-highest-in-nation/
Idaho Has High Rate of Students Exempted from Vaccinations ...
https://www.usnews.com/news/healthiest-communities/articles/2018-05-07/idaho-has-high-rate-of-students-exempted-from-vaccinations
Bwuahahaha!
 |
| http://www.nvic.org/Vaccine-Laws/state-vaccine-requirements/idaho.aspx http://vaclib.org/exempt/idaho.htm http://vaccinetruth.net/exempt/idaho.htm |
TITLE 39
HEALTH AND SAFETY
CHAPTER 48
IMMUNIZATION
39-4802. EXEMPTIONS. (1) Any minor child whose parent or guardian has submitted to school officials a certificate signed by a physician licensed by the state board of medicine stating that the physical condition of the child is such that all or any of the required immunizations would endanger the life or health of the child shall be exempt from the provisions of this chapter.
(2) Any minor child whose parent or guardian has submitted a signed statement to school officials stating their objections on religious or other grounds shall be exempt from the provisions of this chapter.
History:
[(39-4802) 1978, ch. 240, sec. 1, p. 624; am. and redesignated 1979, ch. 313, sec. 2, p. 846.]
https://legislature.idaho.gov/statutesrules/idstat/title39/t39ch48/sect39-4802/
TITLE 39
HEALTH AND SAFETY
CHAPTER 48
IMMUNIZATION
39-4804. NOTIFICATION TO PARENT OR GUARDIAN. (1) Before an immunization is administered to any child in this state, the parent or guardian of the child shall be notified that:
(a) Immunizations are not mandatory and may be refused on religious or other grounds;
(b) Participation in the immunization registry is voluntary;
(c) The parent or guardian is entitled to an accurate explanation of the complications known to follow such immunization.
.
Thursday, September 12, 2019
OHIOIANS! YOUR VOICE WAS HEARD!
Ohio Advocates for Medical Freedom
July 16
YOUR VOICE WAS HEARD!
Section 3313.671F of Ohio HB166, an amendment to the budget bill that would remove vaccine exemption rights from some Ohio school students, was removed from the bill tonight before the bill was passed to make its way to the Governor.
Ohioans from all over the state sent tens of thousands of emails, made thousands of phone calls, and visited committee members and their own district legislators in-person... and your voices were heard!
Consider sending the committee members a thank you note for listening to YOU! Find their contact info here: www.OhioAMF.org/HB166
You can also automatically send them all a Thank You postcard directly from our website: www.OhioAMF.org/HB166-TYPC
Ohio's exemptions STILL Stand!
Since Ohio still have their exemptions intact, I'm going to post all that we find and have found online RIGHT HERE in this post. Download any and all of these forms even if you're in another state, as links disappear, sites change links, and/or go down. You will want to share them with your friends from the states who have the forms and for those who need them. Some of these links to the forms are from actual school districts, who may want parents to use THEIR form for their records. Some of the forms are generic and can be used for any school which have no forms listed online.
Ohio Immunization Exemption Form | Symmes Chiropractic Center
The State of Ohio allows parents/guardians to exempt their child from "mandatory" vaccinations for philosophical or religious convictions. This form will enable the parent to clearly state to the school or institution the revised Ohio code legally allowing a child not to be vaccinated. Note, privatized institutions may not except this form, due to the fact they have the ability to create their own internal regulations.
http://symmeschiro.com/files/OH%20Immunization%20Exemption.pdf
[DOC] state of ohio - Exemptions
www.vaccinetruth.net › letters › Ohio-Exemption-Form
[PDF] Departments Health Services Immunization Exemption form
https://www.dps.k12.oh.us/documents/contentdocuments/doc_23_5_4.pdf
[PDF] State of Ohio Legal Immunization Exemption Per Ohio Statute ...
http://www.galionschools.org/upload/documents/immunizationexemption.pdf
[PDF] State of Ohio Immunization Exemption Form - Northwestern ...
http://www.northwestern-wayne.k12.oh.us/Downloads/Immunization%20Exemption%20Form%20-%20Revised%202016%20-.pdf
[PDF] Immunization Exemption Form - Chagrin Falls Schools
http://www.chagrinschools.org/Downloads/Immunization%20Exemption%20Form.pdf
STATE OF OHIO LEGAL IMMUNIZATION EXEMPTION Per Ohio Statute 3313.671 https://www.aldersgatechristian.com/wp-content/uploads/2017/07/Immunization-Exemption-Form.pdf
[PDF] Immunization Exemption Form - 4-H Camp Ohio
https://www.4hcampohio.org/uploads/6/9/7/7/69771775/2017_immunization_exemption_form.pdf
[PDF] Request of Exemption from Immunizations
http://www.bwls.net/Downloads/Request%20For%20Exemption%20from%20Immunizations2.pdf
[PDF] Exemption - The Ohio State University
https://shs.osu.edu/posts/documents/vaccination-requirement-general-non-medical-exemption.pdf
* Notary required
[PDF] medical, religious, or philosophical exemption form
https://www.hb.edu/uploaded/Portals/All_School/Resources/Health_Services/Immunization_Exemption.pdf
Miamisburg City Schools
540 E. Park Avenue
Miamisburg, Ohio 45342
Immunization Exemption Form K-12
https://www.miamisburgcityschools.org/images/Files/Immunization%20Exemption%20Form%20K-12.pdf
Immunizations and Forms | WholeKids Pediatrics
http://www.wholekidspediatrics.com/media/documents/OH_Immunization_Exemption.pdf
* Can you freaking believe this?!! A pediatrician's office linking to a vaccine exemption form on their website!!!
Experimental Vaccines:
http://experimentalvaccines.org/wp-content/uploads/2013/06/Ohio-Religious-Vaccine-Exemption-Form.pdf
Health Services - Richmond Heights Schools
www.richmondheightsschools.org › HealthServices
http://www.richmondheightsschools.org/Downloads/Exemption%20Letter2.docx
TROY CHRISTIAN SCHOOLS
1586 McKaig Avenue, Troy OH 45373 (937) 339-5692 (937) 335-6258 - Fax
State of Ohio
Legal Immunization Exemption on Medical Grounds
https://static1.squarespace.com/static/5553f59de4b0bc7084988ae9/t/55c2853ce4b03ff07cf436ef/1438811452379/Legal___Religious_Medical_Exemption.pdf
Please list the immunizations objected to:
How about ALL OF THEM?!!
[PDF] Immunization Exemption - Dublin City Schools
http://www.dublinschools.net/Downloads/5320%20F2%20Immunization%20Exemption9.pdf
[PDF] IMMUNIZATION EXEMPTION FORM Ohio Revised Code Sections 3313.67 and 3313.671 - Neola
http://neola.com/triad-oh/search/forms/fm5320F2.pdf
Forms - Oakwood City School District
https://www.oakwoodschools.org/fs/resource-manager/view/4822334c-c2f1-491b-96a3-7c724ca62c41
Delaware City Schools
74 W. William Street
Delaware, OH 43015
http://www.neola.com/delaware-oh/search/forms/fm5320F2.pdf
School Health Services :: Stow-Munroe Falls City Schools
Stow, Ohio 44224
http://smfschools.org/download_file/force/4554/1095
Health Services - Brecksville - Broadview Heights
Brecksville – Broadview Heights City School District
6638 Mill Road | Brecksville, Ohio 44141
http://www.bbhcsd.org/Downloads/IMMUNIZATION%20EXEMPTION%20letter%205320F1A%2016.pdf
Springboro Community City School District
1685 S. Main Street Springboro, OH 45066
Health Forms and Information - Springboro Schools
K-12 Immunization Exemption Letter
http://www.springboro.org/Downloads/K-12%20immunization%20exemption%20letter.doc
Forms - North Ridgeville City Schools
34620 Bainbridge Road
North Ridgeville, OH 44039
https://drive.google.com/file/d/1DgItF0NP68NhvXYXT6y-gJtFdrCGXaJU/view?usp=sharing
Cloverleaf Local Schools
8525 Friendsville Road
Lodi, Ohio 44254
https://www.cloverleaflocal.org/Downloads/Immunization%20Waiver%20Form3%20Updated%20Feb%202019.pdf
Some forms are asking for reasons, although it's not required to give one, other than check off religious or "good cause", which is philosophical/personal exemption.
But here are a few just in case
We do not give our consent for our child to receive vaccinations or immunizations in any
form including injection, nasal mist, oral medication or any other method of delivery. Our
beliefs prohibit such practices. This declaration is in accordance with the Ohio Statute
3313.671 - exemptions for reasons of conscience including religious convictions.
From one of Vaccination Liberation Exemption pages
"If I claim exemption for religious reasons, I will submit a statement that a particular vaccination is contrary to my religious beliefs (address listed below)..."
Good religious reasons...
These constitute good reasons when a school or college asks for your religious reason on a form that says, state your reason here, attach rationale, or state why a particular vaccination is contrary to your religious beliefs, etc...
Often you will be requested to state your rationale for your vaccination exemption petition. What follows is what is used for public schools, parochial schools, private colleges, and public universities.
Q: What constitutes a religious conflict with vaccination?
A: All vaccines are made in violation of God’s Word. Vaccines are made with toxic chemicals that are injected into the bloodstream by vaccination. All vaccines are made with foreign proteins (viruses and bacteria), and some vaccines are made with genetically engineered viral and bacterial materials.
A conflict arises if you believe that man is made in God’s image and the injection of toxic chemicals and foreign proteins into the bloodstream is a violation of God’s directive to keep the body/temple holy and free from impurities.
Vaccines are produced in animal tissues. A conflict arises if you accept God’s warning not to mix the blood of man with the blood of animals. Some vaccines are produced in aborted fetal tissue.
A conflict arises if your religious convictions are predicated on the belief that all life is sacred. God’s commandment “Thou Shall Not Kill” applies to the practice of abortion. When it is believed that the practice of abortion should not be encouraged or supported in any manner, a conflict may arise with vaccines produced in aborted fetal tissue even though you didn’t have anything to do with the abortions from which the vaccines are made from.
The Hepatitis-A vaccine containing MRC-5 is obtained from human babies that were electively aborted. WI-38 was created from the tissue of an aborted fetus and is used for the rubella portion of the MMR-II vaccine. RA 273 was created from the tissue of an aborted fetus, and is used for MMR-II vaccine. A conflict arises because my religious convictions are predicated on the belief that all life is sacred. God's commandment "Thou Shall Not Kill" applies to the practice of abortion. The acceptance of this/these vaccine(s) promotes/promote abortion and violates the Sixth Commandment of "Thou Shall Not Kill".
The Chickenpox (Varivax) vaccine containing MRC-5 and RA 273, is obtained from human babies that were electively aborted. The acceptance of this vaccine promotes abortion and violates the Sixth Commandment of "Thou Shall Not Kill".
The Hepatitis-B vaccine supposedly protects against a disease that is only transmitted through multiple sexual partners or street IV drug users. The acceptance of this vaccine promotes sexual promiscuity and immoral behavior in direct contradiction to the teachings of my faith.
For a child under age 18, where parent has to make the statement, concerning Hep B vaccine...
The Hepatitis-B vaccine supposedly protects against a disease that is only transmitted through multiple sexual partners or street IV drug users and therefore usurps my parental authority to condemn such activity in my child. The acceptance of this vaccine promotes sexual promiscuity and immoral behavior in direct contradiction to the teachings of our faith.
”I believe that inherent in each individual is an innate intelligence, provided by God, which will protect the host environment and provide homeostasis.” “Life and physical health are precious gifts entrusted to us by God. We must take reasonable care of them…” [2288 – Catechism of the Catholic Church 1994]
“The virtue of temperance disposes us to avoid every kind of excess: the abuse of … medicine.” [2290 – Catechism of the Catholic Church 1994]
(Indicate rationale and attach statement from clergy or other authority.)
You do not need to belong to a church or religious organization to claim religious exemption from vaccines.
Applicable law has been interpreted to mean that a religious belief is subject to protection even though no religious group espouses such beliefs or the fact that the religious group to which the individual professes to belong may not advocate or require such belief. Title VII of the Civil Rights Act of 1964 as amended Nov. 1, 1980; Part 1605.1-Guidelines on Discrimination Because of Religion.
Our legal rights are guaranteed by the free exercise clause of the First Amendment to the U.S. Constitution. Recent court decisions have upheld the rights of individuals seeking exemptions from immunizations based upon personal and religious reasons. On the U.S. Supreme Court level in Frazee V. Illinois Dept. of Security, 489 U.S. 829, it was found that a state may not deny an exemption simply because a person is not a member of a formal religious organization.
-
July 16
YOUR VOICE WAS HEARD!
Section 3313.671F of Ohio HB166, an amendment to the budget bill that would remove vaccine exemption rights from some Ohio school students, was removed from the bill tonight before the bill was passed to make its way to the Governor.
Ohioans from all over the state sent tens of thousands of emails, made thousands of phone calls, and visited committee members and their own district legislators in-person... and your voices were heard!
Consider sending the committee members a thank you note for listening to YOU! Find their contact info here: www.OhioAMF.org/HB166
You can also automatically send them all a Thank You postcard directly from our website: www.OhioAMF.org/HB166-TYPC
Ohio's exemptions STILL Stand!
Since Ohio still have their exemptions intact, I'm going to post all that we find and have found online RIGHT HERE in this post. Download any and all of these forms even if you're in another state, as links disappear, sites change links, and/or go down. You will want to share them with your friends from the states who have the forms and for those who need them. Some of these links to the forms are from actual school districts, who may want parents to use THEIR form for their records. Some of the forms are generic and can be used for any school which have no forms listed online.
Ohio Immunization Exemption Form | Symmes Chiropractic Center
The State of Ohio allows parents/guardians to exempt their child from "mandatory" vaccinations for philosophical or religious convictions. This form will enable the parent to clearly state to the school or institution the revised Ohio code legally allowing a child not to be vaccinated. Note, privatized institutions may not except this form, due to the fact they have the ability to create their own internal regulations.
http://symmeschiro.com/files/OH%20Immunization%20Exemption.pdf
[DOC] state of ohio - Exemptions
www.vaccinetruth.net › letters › Ohio-Exemption-Form
https://www.dps.k12.oh.us/documents/contentdocuments/doc_23_5_4.pdf
[PDF] State of Ohio Legal Immunization Exemption Per Ohio Statute ...
http://www.galionschools.org/upload/documents/immunizationexemption.pdf
[PDF] State of Ohio Immunization Exemption Form - Northwestern ...
http://www.northwestern-wayne.k12.oh.us/Downloads/Immunization%20Exemption%20Form%20-%20Revised%202016%20-.pdf
[PDF] Immunization Exemption Form - Chagrin Falls Schools
http://www.chagrinschools.org/Downloads/Immunization%20Exemption%20Form.pdf
STATE OF OHIO LEGAL IMMUNIZATION EXEMPTION Per Ohio Statute 3313.671 https://www.aldersgatechristian.com/wp-content/uploads/2017/07/Immunization-Exemption-Form.pdf
[PDF] Immunization Exemption Form - 4-H Camp Ohio
https://www.4hcampohio.org/uploads/6/9/7/7/69771775/2017_immunization_exemption_form.pdf
[PDF] Request of Exemption from Immunizations
http://www.bwls.net/Downloads/Request%20For%20Exemption%20from%20Immunizations2.pdf
[PDF] Exemption - The Ohio State University
https://shs.osu.edu/posts/documents/vaccination-requirement-general-non-medical-exemption.pdf
* Notary required
[PDF] medical, religious, or philosophical exemption form
https://www.hb.edu/uploaded/Portals/All_School/Resources/Health_Services/Immunization_Exemption.pdf
Miamisburg City Schools
540 E. Park Avenue
Miamisburg, Ohio 45342
Immunization Exemption Form K-12
https://www.miamisburgcityschools.org/images/Files/Immunization%20Exemption%20Form%20K-12.pdf
Immunizations and Forms | WholeKids Pediatrics
http://www.wholekidspediatrics.com/media/documents/OH_Immunization_Exemption.pdf
* Can you freaking believe this?!! A pediatrician's office linking to a vaccine exemption form on their website!!!
Experimental Vaccines:
http://experimentalvaccines.org/wp-content/uploads/2013/06/Ohio-Religious-Vaccine-Exemption-Form.pdf
Health Services - Richmond Heights Schools
www.richmondheightsschools.org › HealthServices
http://www.richmondheightsschools.org/Downloads/Exemption%20Letter2.docx
TROY CHRISTIAN SCHOOLS
1586 McKaig Avenue, Troy OH 45373 (937) 339-5692 (937) 335-6258 - Fax
State of Ohio
Legal Immunization Exemption on Medical Grounds
https://static1.squarespace.com/static/5553f59de4b0bc7084988ae9/t/55c2853ce4b03ff07cf436ef/1438811452379/Legal___Religious_Medical_Exemption.pdf
Please list the immunizations objected to:
How about ALL OF THEM?!!
[PDF] Immunization Exemption - Dublin City Schools
http://www.dublinschools.net/Downloads/5320%20F2%20Immunization%20Exemption9.pdf
[PDF] IMMUNIZATION EXEMPTION FORM Ohio Revised Code Sections 3313.67 and 3313.671 - Neola
http://neola.com/triad-oh/search/forms/fm5320F2.pdf
Forms - Oakwood City School District
https://www.oakwoodschools.org/fs/resource-manager/view/4822334c-c2f1-491b-96a3-7c724ca62c41
Delaware City Schools
74 W. William Street
Delaware, OH 43015
http://www.neola.com/delaware-oh/search/forms/fm5320F2.pdf
School Health Services :: Stow-Munroe Falls City Schools
Stow, Ohio 44224
http://smfschools.org/download_file/force/4554/1095
Health Services - Brecksville - Broadview Heights
Brecksville – Broadview Heights City School District
6638 Mill Road | Brecksville, Ohio 44141
http://www.bbhcsd.org/Downloads/IMMUNIZATION%20EXEMPTION%20letter%205320F1A%2016.pdf
Springboro Community City School District
1685 S. Main Street Springboro, OH 45066
Health Forms and Information - Springboro Schools
K-12 Immunization Exemption Letter
http://www.springboro.org/Downloads/K-12%20immunization%20exemption%20letter.doc
Forms - North Ridgeville City Schools
34620 Bainbridge Road
North Ridgeville, OH 44039
https://drive.google.com/file/d/1DgItF0NP68NhvXYXT6y-gJtFdrCGXaJU/view?usp=sharing
Cloverleaf Local Schools
8525 Friendsville Road
Lodi, Ohio 44254
https://www.cloverleaflocal.org/Downloads/Immunization%20Waiver%20Form3%20Updated%20Feb%202019.pdf
Some forms are asking for reasons, although it's not required to give one, other than check off religious or "good cause", which is philosophical/personal exemption.
But here are a few just in case
We do not give our consent for our child to receive vaccinations or immunizations in any
form including injection, nasal mist, oral medication or any other method of delivery. Our
beliefs prohibit such practices. This declaration is in accordance with the Ohio Statute
3313.671 - exemptions for reasons of conscience including religious convictions.
From one of Vaccination Liberation Exemption pages
"If I claim exemption for religious reasons, I will submit a statement that a particular vaccination is contrary to my religious beliefs (address listed below)..."
Good religious reasons...
These constitute good reasons when a school or college asks for your religious reason on a form that says, state your reason here, attach rationale, or state why a particular vaccination is contrary to your religious beliefs, etc...
Often you will be requested to state your rationale for your vaccination exemption petition. What follows is what is used for public schools, parochial schools, private colleges, and public universities.
Q: What constitutes a religious conflict with vaccination?
A: All vaccines are made in violation of God’s Word. Vaccines are made with toxic chemicals that are injected into the bloodstream by vaccination. All vaccines are made with foreign proteins (viruses and bacteria), and some vaccines are made with genetically engineered viral and bacterial materials.
A conflict arises if you believe that man is made in God’s image and the injection of toxic chemicals and foreign proteins into the bloodstream is a violation of God’s directive to keep the body/temple holy and free from impurities.
Vaccines are produced in animal tissues. A conflict arises if you accept God’s warning not to mix the blood of man with the blood of animals. Some vaccines are produced in aborted fetal tissue.
A conflict arises if your religious convictions are predicated on the belief that all life is sacred. God’s commandment “Thou Shall Not Kill” applies to the practice of abortion. When it is believed that the practice of abortion should not be encouraged or supported in any manner, a conflict may arise with vaccines produced in aborted fetal tissue even though you didn’t have anything to do with the abortions from which the vaccines are made from.
The Hepatitis-A vaccine containing MRC-5 is obtained from human babies that were electively aborted. WI-38 was created from the tissue of an aborted fetus and is used for the rubella portion of the MMR-II vaccine. RA 273 was created from the tissue of an aborted fetus, and is used for MMR-II vaccine. A conflict arises because my religious convictions are predicated on the belief that all life is sacred. God's commandment "Thou Shall Not Kill" applies to the practice of abortion. The acceptance of this/these vaccine(s) promotes/promote abortion and violates the Sixth Commandment of "Thou Shall Not Kill".
The Chickenpox (Varivax) vaccine containing MRC-5 and RA 273, is obtained from human babies that were electively aborted. The acceptance of this vaccine promotes abortion and violates the Sixth Commandment of "Thou Shall Not Kill".
The Hepatitis-B vaccine supposedly protects against a disease that is only transmitted through multiple sexual partners or street IV drug users. The acceptance of this vaccine promotes sexual promiscuity and immoral behavior in direct contradiction to the teachings of my faith.
For a child under age 18, where parent has to make the statement, concerning Hep B vaccine...
The Hepatitis-B vaccine supposedly protects against a disease that is only transmitted through multiple sexual partners or street IV drug users and therefore usurps my parental authority to condemn such activity in my child. The acceptance of this vaccine promotes sexual promiscuity and immoral behavior in direct contradiction to the teachings of our faith.
”I believe that inherent in each individual is an innate intelligence, provided by God, which will protect the host environment and provide homeostasis.” “Life and physical health are precious gifts entrusted to us by God. We must take reasonable care of them…” [2288 – Catechism of the Catholic Church 1994]
“The virtue of temperance disposes us to avoid every kind of excess: the abuse of … medicine.” [2290 – Catechism of the Catholic Church 1994]
(Indicate rationale and attach statement from clergy or other authority.)
You do not need to belong to a church or religious organization to claim religious exemption from vaccines.
Applicable law has been interpreted to mean that a religious belief is subject to protection even though no religious group espouses such beliefs or the fact that the religious group to which the individual professes to belong may not advocate or require such belief. Title VII of the Civil Rights Act of 1964 as amended Nov. 1, 1980; Part 1605.1-Guidelines on Discrimination Because of Religion.
Our legal rights are guaranteed by the free exercise clause of the First Amendment to the U.S. Constitution. Recent court decisions have upheld the rights of individuals seeking exemptions from immunizations based upon personal and religious reasons. On the U.S. Supreme Court level in Frazee V. Illinois Dept. of Security, 489 U.S. 829, it was found that a state may not deny an exemption simply because a person is not a member of a formal religious organization.
-
Saturday, June 22, 2019
Pennsylvania bill would end religious, philosophical exemptions from vaccines
Pennsylvania bill would end religious, philosophical exemptions from vaccines
https://www.abc27.com/news/pennsylvania/pennsylvania-bill-would-end-religious-philosophical-exemptions-from-vaccines/
-
-
We have no idea of the status of this bill at the moment, but as soon as I can find out, I will post.
But for now, here are some links to PDF'd exemption forms...
[PDF] Statement of Exemption to Immunization Law ... - Amazon AWS
Same form as above, for this school district:
UPPER PERKIOMEN SCHOOL DISTRICT
2229 East Buck Road
Pennsburg, PA 18073
https://www.upsd.org/uploaded/Special_Ed/Religious_Exemption_Form.pdf
* This form will work for any school, since it’s generic
Experimental Vaccines - Statement of Exemption to Immunization Law Commonwealth of Pennsylvania
http://pamfa.org/wp-content/uploads/2017/04/SAMPLE-EXEMPTION-LETTER.pdf
[DOC] https://informedconsentpa.org/wp-content/uploads/2017/07/Religious_exemption_letter_2017.doc
WALLENPAUPACK AREA SCHOOL DISTRICT
CERTIFICATE OF IMMUNIZATION / IMMUNIZATION EXEMPTION
http://www.wallenpaupack.org/stuff/forms/ImmunizationForm.pdf
* Statement of Exemption at the bottom of the page.
I'll add more later...
-
https://www.abc27.com/news/pennsylvania/pennsylvania-bill-would-end-religious-philosophical-exemptions-from-vaccines/
-
 |
| https://www.nvic.org/Vaccine-Laws/state-vaccine-requirements/pennsylvania.aspx http://www.vaclib.org/exempt/pennsylvania.htm |
We have no idea of the status of this bill at the moment, but as soon as I can find out, I will post.
But for now, here are some links to PDF'd exemption forms...
 |
| [PDF] Statement of Exemption to Immunization Law [JPG] Statement of Exemption to Immunization Law |
[PDF] Statement of Exemption to Immunization Law ... - Amazon AWS
Same form as above, for this school district:
UPPER PERKIOMEN SCHOOL DISTRICT
2229 East Buck Road
Pennsburg, PA 18073
https://www.upsd.org/uploaded/Special_Ed/Religious_Exemption_Form.pdf
* This form will work for any school, since it’s generic
Experimental Vaccines - Statement of Exemption to Immunization Law Commonwealth of Pennsylvania
http://pamfa.org/wp-content/uploads/2017/04/SAMPLE-EXEMPTION-LETTER.pdf
[DOC] https://informedconsentpa.org/wp-content/uploads/2017/07/Religious_exemption_letter_2017.doc
WALLENPAUPACK AREA SCHOOL DISTRICT
CERTIFICATE OF IMMUNIZATION / IMMUNIZATION EXEMPTION
http://www.wallenpaupack.org/stuff/forms/ImmunizationForm.pdf
* Statement of Exemption at the bottom of the page.
I'll add more later...
-
Monday, December 10, 2018
Vaccines There's an exemption for that!
Vaccines There's an exemption for that!
And here are the main exemption pages...
Get out of vaccines, while you still can.
http://www.vaclib.org/exemption.htm
Mirror site: http://vaccinetruth.net/
http://experimentalvaccines.org/vaccine-exemption-forms/
Also, tee shirts and a hoodie called Got Waivers?
And a hoodie for cold weather...
Need to get all these tee shirts/hoodies and other anti-vax stuff up on the vaclib site.
-
 |
| Vaccines There's an exemption for that! T-Shirt |
And here are the main exemption pages...
Get out of vaccines, while you still can.
http://www.vaclib.org/exemption.htm
Mirror site: http://vaccinetruth.net/
http://experimentalvaccines.org/vaccine-exemption-forms/
Also, tee shirts and a hoodie called Got Waivers?
 |
| Got Waivers? T-Shirt |
And a hoodie for cold weather...
 |
| Got Waivers Hoodie |
Need to get all these tee shirts/hoodies and other anti-vax stuff up on the vaclib site.
-
Monday, August 27, 2018
Heads up on vaccine exemptions!
Beware of this new tactic from public schools now…
This one is from Montana (see here), but it’s popping up in schools in other states too. If you have signed a religious exemption letter and receive a letter similar to the one in the next link below, you need to know you do not have to sign such a self incriminating and junk-science letter.
GCCHD Exemption Letter Matt Kelley.pdf
https://www.bsd44.org/wp-content/uploads/2018/03/religious-exemption-form.pdf
Apparently we or something has driven the snake of self-incriminating exemption forms underground, so now the "health departments" wait until the exemption is filed then hits them with this B S. ~Dewey Duffel
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This one is from Montana (see here), but it’s popping up in schools in other states too. If you have signed a religious exemption letter and receive a letter similar to the one in the next link below, you need to know you do not have to sign such a self incriminating and junk-science letter.
GCCHD Exemption Letter Matt Kelley.pdf
https://www.bsd44.org/wp-content/uploads/2018/03/religious-exemption-form.pdf
 |
| http://vaclib.org/exempt/montana.htm#addinfo |
Apparently we or something has driven the snake of self-incriminating exemption forms underground, so now the "health departments" wait until the exemption is filed then hits them with this B S. ~Dewey Duffel
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Tuesday, July 24, 2018
Missouri Vaccine Exemptions
Missouri Exemptions from this blog...
https://harmonyhealth.wordpress.com/2009/08/13/missouri-immunization-exemption-forms/
Be sure to download any and all forms from ALL states as links tend to get taken down.
FOR OBVIOUS REASONS. Ahem!
The reasoning is that they can be shared with family and friends who may reside in another state. This is YOUR way of helping us all out. Put them on your websites, Dropbox, wordpress blogs, social media or any other cloud storage.
__________________________________________________________________
Dear school administrator,
It is against my personal religious beliefs to inject man made foreign chemicals into my child’s body. As the ultimate party of responsibility I do hereby object to all immunizations and fluoride treatments.
According to
Missouri Revised Statutes
Chapter 167
Pupils and Special Services
Section 167.181
August 28, 2008
3. This section shall not apply to any child if one parent or guardian objects in writing to his school administrator against the immunization of the child, because of religious beliefs or medical contraindications. In cases where any such objection is for reasons of medical contraindications, a statement from a duly licensed physician must also be provided to the school administrator.
Further, I will consider any attempt to administer vaccines or fluoride treatments to my child an assault and criminal charges will be filed against the individual administering the assault, and all responsible administrators.
Please feel free to contact me if there are any questions.
Sincerely,
Your name
______________________________________________________________
Some schools may require the state forms in addition to the above letter or stand alone. Depends on the school and/or district.
Religious Exemption Forms Missouri:
http://neputewellnesscenter.com/wp-content/uploads/Missouri-Religious-Immunization-Exemption-Form.pdf
http://experimentalvaccines.org/wp-content/uploads/2013/06/Missouri-Religious-Immunization-Exemption-Form.pdf
-
Medical Exemption Form Missouri:
Bunker R-III School District
HWY 72 & Eagle Pride Drive
Bunker, MO 63629
http://bunkerr3.k12.mo.us/PDF_Files/Medical_Immunization_Exemption.pdf
* The above form is for the whole state, fyi.
-
https://harmonyhealth.wordpress.com/2009/08/13/missouri-immunization-exemption-forms/
Be sure to download any and all forms from ALL states as links tend to get taken down.
FOR OBVIOUS REASONS. Ahem!
The reasoning is that they can be shared with family and friends who may reside in another state. This is YOUR way of helping us all out. Put them on your websites, Dropbox, wordpress blogs, social media or any other cloud storage.
__________________________________________________________________
Dear school administrator,
It is against my personal religious beliefs to inject man made foreign chemicals into my child’s body. As the ultimate party of responsibility I do hereby object to all immunizations and fluoride treatments.
According to
Missouri Revised Statutes
Chapter 167
Pupils and Special Services
Section 167.181
August 28, 2008
3. This section shall not apply to any child if one parent or guardian objects in writing to his school administrator against the immunization of the child, because of religious beliefs or medical contraindications. In cases where any such objection is for reasons of medical contraindications, a statement from a duly licensed physician must also be provided to the school administrator.
Further, I will consider any attempt to administer vaccines or fluoride treatments to my child an assault and criminal charges will be filed against the individual administering the assault, and all responsible administrators.
Please feel free to contact me if there are any questions.
Sincerely,
Your name
______________________________________________________________
Some schools may require the state forms in addition to the above letter or stand alone. Depends on the school and/or district.
Religious Exemption Forms Missouri:
http://neputewellnesscenter.com/wp-content/uploads/Missouri-Religious-Immunization-Exemption-Form.pdf
http://experimentalvaccines.org/wp-content/uploads/2013/06/Missouri-Religious-Immunization-Exemption-Form.pdf
-
Medical Exemption Form Missouri:
Bunker R-III School District
HWY 72 & Eagle Pride Drive
Bunker, MO 63629
http://bunkerr3.k12.mo.us/PDF_Files/Medical_Immunization_Exemption.pdf
* The above form is for the whole state, fyi.
 |
| http://neputewellnesscenter.com/wp-content/uploads/Screen-Shot-2017-06-29-at-3.22.25-PM.png |
-
Monday, October 23, 2017
Vaccine Exemptions (Letters and Forms) for Massachusetts
I'm working on stuff like this today.
For Massachusetts...
[DOC] AFFIDAVIT
AFFIDAVIT-for-Massachusetts-Adult-college.doc
http://www.vaclib.org/letters/AFFIDAVIT-for-Massachusetts-Adult-college.doc
http://vaccinetruth.net/letters/AFFIDAVIT-for-Massachusetts-Adult-college.doc
* Could be edited to use for employment situations.
[DOC] AFFIDAVIT
AFFIDAVIT for Massachusetts Older Child.doc
http://www.vaclib.org/letters/AFFIDAVIT%20for%20Massachusetts%20Older%20Child.doc
http://vaccinetruth.net/letters/AFFIDAVIT%20for%20Massachusetts%20Older%20Child.doc
[PDF ]Religious Exemption Sign Off - Chelmsford Public Schools
Religious Exemption from Immunization Requirements
Chelmsford Public Schools
https://www.chelmsford.k12.ma.us/site/handlers/filedownload.ashx?moduleinstanceid=2635&dataid=2184&FileName=Religious%20Exemption%20Sign%20Off.pdf
And this one from one of my earlier posts...
MessiahMews Blogs: VACCINE - PERSONALIZED Religious Exemption with scriptural support...: Cleaned it up as well as I could... for Massachusetts... https://docs.google.com/document/d/1l3Uh3G37EM5RMVrP3jWy1b3vRstEJt4mgxMYkZ9FT3U/mobilebasic...
VACCINE - PERSONALIZED Religious Exemption with scriptural support
https://messiahmews.blogspot.com/2017/09/vaccine-personalized-religious.html
Vaccination Exemption Certificate
From this page:
http://www.moresureword.com/Pestilence.htm
Read----Psalm 91 & Psalm 46 that is the way we will go. Under NO circumstances will we take vaccinations government enforced or otherwise. Research vaccines before you would consider taking them. Most are dangerous. We will take Vitamin C and Colloidal Silver and TRUST The Lord.
For Me and My House
We will NOT receive the Vaccination.
We Have Valid FAITH and/or Religious
VACCINATION EXEMPTION.
With the Exemption not even the State of Massachusetts
can FORCE the Vaccine upon us.
Full sized graphic:
http://www.moresureword.com/Pestil3.jpg
-----
VACCINE - PERSONALIZED Religious Exemption with scriptural support.docx
http://vaclib.org/docs/Exemption-with-scriptural-support.docx
Sample religious exemption letters for MA schools - Mothering Forums
http://www.mothering.com/forum/83-connecticut-massachusetts-rhode-island/1182604-sample-religious-exemption-letters-ma-schools.html
***********
Notice of Religious Exemption to Vaccinations
NAME, SCHOOL
As per General Laws of Massachusetts chapter 76, section 15C (Vaccination and Immunization; Exceptions by Reason of Physical Condition or Religious Belief) I am exempting myself from vaccination because it conflicts with my sincerely held religious belief.
_________________________________
NameDate
M.G.L. c. 76, ss 15C;
§ 15. Vaccination and Immunization; Exceptions by Reason of Physical Condition or Religious Belief.
No child shall, except as hereinafter provided, be admitted to school except upon presentation of a physician's certificate that the child has been successfully immunized against diphtheria, pertussis, tetanus, measles and poliomyelitis and such other communicable diseases as may be specified from time to time by the department of public health.
A child shall be admitted to school upon certification by a physician that he has personally examined such child and that in his opinion the physical condition of the child is such that his health would be endangered by such vaccination or by any of such immunizations. Such certification shall be submitted at the beginning of each school year to the physician in charge of the school health program. If the physician in charge of the school health program does not agree with the opinion of the child's physician, the matter shall be referred to the department of public health, whose decision will be final.
In the absence of an emergency or epidemic of disease declared by the department of public health, no child whose parent or guardian states in writing that vaccination or immunization conflicts with his sincere religious beliefs shall be required to present said physician's certificate in order to be admitted to school.
105 CMR 220.600 (2007)
220.600: Immunization Requirements for Postsecondary Students
(A) No student, as specified in 105 CMR 220.400(C) and 220.600(B), shall attend a postsecondary institution without a certification of immunization, as specified in 105 CMR 220.600(C). For purposes of 105 CMR 220.600, "postsecondary institution" shall mean a college, university, institute or school accredited as a postsecondary institution by the New England Association of Schools and Colleges.
(B) The following students are subject to the requirements of 105 CMR 220.600(C):
(1) full-time undergraduate and graduate students;
(2) part-time undergraduate and graduate students in a health science program who may be in contact with patients; and
(3) beginning on January 1, 1999, any full or part-time student attending an institution of higher education in Massachusetts while on a student or other visa, including a student attending or visiting classes or programs as part of a formal academic visitation or exchange program.
(C) Each student subject to 105 CMR 220.600(B) must present a certificate of immunization that the student has received the following immunizations:
(1) at least one dose of mumps and rubella vaccine(s) given at or after 12 months of age;
(2) two doses of live measles vaccine given at least one month apart beginning at or after 12 months of age;
(3) a booster dose of Td within the last ten years;
(4) beginning on September 1, 2000, 3 doses of hepatitis B vaccine will be required for all students in a health science program who may be in contact with patients. After September 1, 2005, this requirement shall apply to all students subject to 105 CMR 220.600.
(D) The requirements of 105 CMR 220.600 shall not apply where:
(1) the student provides written documentation that he or she meets the standards for medical or religious exemption set forth in M.G.L. c. 76, ss 15C;
(2) the student provides appropriate documentation, including a copy of a school immunization record, indicating receipt of the required immunizations; or
(3) in the case of measles, mumps, rubella and hepatitis B, the student presents laboratory evidence of immunity.
(E) Whenever possible, such immunizations are to be obtained prior to enrollment or registration. However, students subject to 105 CMR 220.600 may be enrolled or registered provided that the required immunizations are obtained within 30 days of registration and provided, further, that the postsecondary institution has policies and procedures for ascertaining which students have failed to obtain the necessary immunizations within 30 days, and for taking appropriate follow up action to ensure compliance with 105 CMR 220.00.
***********
Daycare
***********
Notice of Religious Exemption to Vaccinations
To whom this may concern,
We, parents names, are exempting our child, child's name, from all vaccinations because it conflicts with our sincerely held religious belief.
IMMUNIZATION REQUIREMENTS FOR GROUP DAY CARE AND
SCHOOL AGE CHILD CARE PROGRAMS
Regulations Of The Department of Early Education and Care
102 CMR 7.00: Standards For The Licensure Or Approval Of Group Day Care And School Age Child Care Programs (7/10/97)
Section 102 CMR 7.09(5)(a) Required Medical Examinations in Group Child Care Programs
“The licensee shall require, at admission, a physician’s certificate that each child has been successfully immunized in accordance with the current Department of Public Health’s recommended schedules against diphtheria, tetanus, pertussis (whooping cough), poliomyelitis, measles and such other communicable diseases as may be specified from time to time by the Office. No child shall be required, under 102 CMR 7.00 to have any such immunization if his parent(s) objects thereto, in writing, on the grounds that it conflicts with their religious beliefs or if the child’s physician submits documentation that such a procedure is contraindicated.”
Sincerely,
Names of parents
-----
Colleges and University Forms:
Becker College
Notice of Medical/Religious Exception to Vaccination(s)
http://www.becker.edu/wp-content/uploads/2012/12/3-Becker-medical-or-religious-waiver-form.pdf
Wheaton College
PHYSICAL EXAM/IMMUNIZATION WAIVER FOR RELIGIOUS/MEDICAL REASONS
http://wheatoncollege.edu/wp-content/uploads/2010/07/WAIVER-FOR-RELIGIOUS.MEDICAL-REASONS-2016.pdf
[PDF] Immunization Exemption Form - Babson College
http://www.babson.edu/student-life/health-wellness/health-services/Documents/request-for-immunization-exemption.pdf
Vaccination Liberation:
http://www.vaclib.org/exempt/massachusetts.htm
http://vaccinetruth.net/exempt/massachusetts.htm
Some forms from Experimental Vaccines here too:
http://experimentalvaccines.org/vaccine-exemption-forms/massachusetts/
-----
For Massachusetts...
[DOC] AFFIDAVIT
AFFIDAVIT-for-Massachusetts-Adult-college.doc
http://www.vaclib.org/letters/AFFIDAVIT-for-Massachusetts-Adult-college.doc
http://vaccinetruth.net/letters/AFFIDAVIT-for-Massachusetts-Adult-college.doc
* Could be edited to use for employment situations.
[DOC] AFFIDAVIT
AFFIDAVIT for Massachusetts Older Child.doc
http://www.vaclib.org/letters/AFFIDAVIT%20for%20Massachusetts%20Older%20Child.doc
http://vaccinetruth.net/letters/AFFIDAVIT%20for%20Massachusetts%20Older%20Child.doc
[PDF ]Religious Exemption Sign Off - Chelmsford Public Schools
Religious Exemption from Immunization Requirements
Chelmsford Public Schools
https://www.chelmsford.k12.ma.us/site/handlers/filedownload.ashx?moduleinstanceid=2635&dataid=2184&FileName=Religious%20Exemption%20Sign%20Off.pdf
And this one from one of my earlier posts...
MessiahMews Blogs: VACCINE - PERSONALIZED Religious Exemption with scriptural support...: Cleaned it up as well as I could... for Massachusetts... https://docs.google.com/document/d/1l3Uh3G37EM5RMVrP3jWy1b3vRstEJt4mgxMYkZ9FT3U/mobilebasic...
VACCINE - PERSONALIZED Religious Exemption with scriptural support
https://messiahmews.blogspot.com/2017/09/vaccine-personalized-religious.html
Vaccination Exemption Certificate
From this page:
http://www.moresureword.com/Pestilence.htm
Read----Psalm 91 & Psalm 46 that is the way we will go. Under NO circumstances will we take vaccinations government enforced or otherwise. Research vaccines before you would consider taking them. Most are dangerous. We will take Vitamin C and Colloidal Silver and TRUST The Lord.
For Me and My House
We will NOT receive the Vaccination.
We Have Valid FAITH and/or Religious
VACCINATION EXEMPTION.
With the Exemption not even the State of Massachusetts
can FORCE the Vaccine upon us.
Full sized graphic:
http://www.moresureword.com/Pestil3.jpg
-----
VACCINE - PERSONALIZED Religious Exemption with scriptural support.docx
http://vaclib.org/docs/Exemption-with-scriptural-support.docx
Sample religious exemption letters for MA schools - Mothering Forums
http://www.mothering.com/forum/83-connecticut-massachusetts-rhode-island/1182604-sample-religious-exemption-letters-ma-schools.html
***********
Notice of Religious Exemption to Vaccinations
NAME, SCHOOL
As per General Laws of Massachusetts chapter 76, section 15C (Vaccination and Immunization; Exceptions by Reason of Physical Condition or Religious Belief) I am exempting myself from vaccination because it conflicts with my sincerely held religious belief.
_________________________________
NameDate
M.G.L. c. 76, ss 15C;
§ 15. Vaccination and Immunization; Exceptions by Reason of Physical Condition or Religious Belief.
No child shall, except as hereinafter provided, be admitted to school except upon presentation of a physician's certificate that the child has been successfully immunized against diphtheria, pertussis, tetanus, measles and poliomyelitis and such other communicable diseases as may be specified from time to time by the department of public health.
A child shall be admitted to school upon certification by a physician that he has personally examined such child and that in his opinion the physical condition of the child is such that his health would be endangered by such vaccination or by any of such immunizations. Such certification shall be submitted at the beginning of each school year to the physician in charge of the school health program. If the physician in charge of the school health program does not agree with the opinion of the child's physician, the matter shall be referred to the department of public health, whose decision will be final.
In the absence of an emergency or epidemic of disease declared by the department of public health, no child whose parent or guardian states in writing that vaccination or immunization conflicts with his sincere religious beliefs shall be required to present said physician's certificate in order to be admitted to school.
105 CMR 220.600 (2007)
220.600: Immunization Requirements for Postsecondary Students
(A) No student, as specified in 105 CMR 220.400(C) and 220.600(B), shall attend a postsecondary institution without a certification of immunization, as specified in 105 CMR 220.600(C). For purposes of 105 CMR 220.600, "postsecondary institution" shall mean a college, university, institute or school accredited as a postsecondary institution by the New England Association of Schools and Colleges.
(B) The following students are subject to the requirements of 105 CMR 220.600(C):
(1) full-time undergraduate and graduate students;
(2) part-time undergraduate and graduate students in a health science program who may be in contact with patients; and
(3) beginning on January 1, 1999, any full or part-time student attending an institution of higher education in Massachusetts while on a student or other visa, including a student attending or visiting classes or programs as part of a formal academic visitation or exchange program.
(C) Each student subject to 105 CMR 220.600(B) must present a certificate of immunization that the student has received the following immunizations:
(1) at least one dose of mumps and rubella vaccine(s) given at or after 12 months of age;
(2) two doses of live measles vaccine given at least one month apart beginning at or after 12 months of age;
(3) a booster dose of Td within the last ten years;
(4) beginning on September 1, 2000, 3 doses of hepatitis B vaccine will be required for all students in a health science program who may be in contact with patients. After September 1, 2005, this requirement shall apply to all students subject to 105 CMR 220.600.
(D) The requirements of 105 CMR 220.600 shall not apply where:
(1) the student provides written documentation that he or she meets the standards for medical or religious exemption set forth in M.G.L. c. 76, ss 15C;
(2) the student provides appropriate documentation, including a copy of a school immunization record, indicating receipt of the required immunizations; or
(3) in the case of measles, mumps, rubella and hepatitis B, the student presents laboratory evidence of immunity.
(E) Whenever possible, such immunizations are to be obtained prior to enrollment or registration. However, students subject to 105 CMR 220.600 may be enrolled or registered provided that the required immunizations are obtained within 30 days of registration and provided, further, that the postsecondary institution has policies and procedures for ascertaining which students have failed to obtain the necessary immunizations within 30 days, and for taking appropriate follow up action to ensure compliance with 105 CMR 220.00.
***********
Daycare
***********
Notice of Religious Exemption to Vaccinations
To whom this may concern,
We, parents names, are exempting our child, child's name, from all vaccinations because it conflicts with our sincerely held religious belief.
IMMUNIZATION REQUIREMENTS FOR GROUP DAY CARE AND
SCHOOL AGE CHILD CARE PROGRAMS
Regulations Of The Department of Early Education and Care
102 CMR 7.00: Standards For The Licensure Or Approval Of Group Day Care And School Age Child Care Programs (7/10/97)
Section 102 CMR 7.09(5)(a) Required Medical Examinations in Group Child Care Programs
“The licensee shall require, at admission, a physician’s certificate that each child has been successfully immunized in accordance with the current Department of Public Health’s recommended schedules against diphtheria, tetanus, pertussis (whooping cough), poliomyelitis, measles and such other communicable diseases as may be specified from time to time by the Office. No child shall be required, under 102 CMR 7.00 to have any such immunization if his parent(s) objects thereto, in writing, on the grounds that it conflicts with their religious beliefs or if the child’s physician submits documentation that such a procedure is contraindicated.”
Sincerely,
Names of parents
-----
Colleges and University Forms:
Becker College
Notice of Medical/Religious Exception to Vaccination(s)
http://www.becker.edu/wp-content/uploads/2012/12/3-Becker-medical-or-religious-waiver-form.pdf
Wheaton College
PHYSICAL EXAM/IMMUNIZATION WAIVER FOR RELIGIOUS/MEDICAL REASONS
http://wheatoncollege.edu/wp-content/uploads/2010/07/WAIVER-FOR-RELIGIOUS.MEDICAL-REASONS-2016.pdf
[PDF] Immunization Exemption Form - Babson College
http://www.babson.edu/student-life/health-wellness/health-services/Documents/request-for-immunization-exemption.pdf
Vaccination Liberation:
http://www.vaclib.org/exempt/massachusetts.htm
http://vaccinetruth.net/exempt/massachusetts.htm
Some forms from Experimental Vaccines here too:
http://experimentalvaccines.org/vaccine-exemption-forms/massachusetts/
-----
Saturday, August 19, 2017
Vaccine Exemption Forms & Letters For Pennsylvania, Louisiana, and Maryland
More exemption forms and letters for the following states. We will be adding more forms to this, if we find more of them in the same states.
-----
Pennsylvania:
Statement of Exemption to Immunization Law
Commonwealth of Pennsylvania
Medical exemption - when the physical condition of the child is such that immunization would endanger life or health. (Requires Physician's signature.)
Religious exemption –when the parent/guardian adheres to a religious belief whose teachings are opposed to such immunizations. (Requires parent/guardian signature.)
Statement of Exemption to Immunization Law:
Commonwealth of Pennsylvania
http://www.woodmed.com/html/Exemption_to_Immunization_Law.html
http://experimentalvaccines.org/wp-content/uploads/2013/06/Pennsylvania-Statement-of-Exemption-to-Immunization-Form.pdf
Statement of Exemption to Immunization Law:
Commonwealth of Pennsylvania
http://www.pbsd.k12.pa.us/Downloads/Religious%20Exemption%20Form2.pdf
[PDF] immunization exemption letter - pamfa
http://pamfa.org/wp-content/uploads/2017/04/SAMPLE-EXEMPTION-LETTER.pdf
[DOCX] immunization exemption letter - pamfa
http://pamfa.org/wp-content/uploads/2017/04/SAMPLE-EXEMPTION-LETTER.docx
-----
Louisiana:
STATEMENT OF EXEMPTION FROM IMMUNIZATIONS
Louisiana Dept. of Education
https://www.louisianabelieves.com/docs/default-source/early-childhood/statement-of-exemption-from-immunizations.pdf
-----
Maryland:
VACCINATION EXEMPTION PURSUANT TO THE MARYLAND STATUTE § 7-403
§7-403 (b) Exception.
(1) Unless the Secretary of Health and Mental Hygiene declares an emergency or an epidemic of disease, a child whose parent or guardian objects to immunization on the ground that it conflicts with the parent’s or guardian’s bona fide religious beliefs and practices may not be required to present a physician’s certificate of immunization in order to be admitted to school
(2) The Secretary of Health and Mental Hygiene shall adopt rules and regulations for religious exemptions under this subsection.
____________________________________________________________
VACCINE EXEMPTION FORM
http://www.dswashington.org/files/dswashington/Dateien/b2013/Verwaltung/12_04_11_Vaccination_Exemption.pdf
http://www.brainfoodcookbook.com/ExemptionVacLib-Maryland.pdf
http://experimentalvaccines.org/vaccine-exemption-forms/maryland/
Or you can sign off at the bottom of the Maryland Certificate of Immunization.
https://www.barrie.org/uploaded/Camp_Files/ImmunizationCertificate.pdf
-----
The Truth About Vaccines Docu-series re-launch Ep 3 airs tonight.
3.August 19 - Episode 3: An Analysis of the MMR & DTaP Vaccines & Vaccinating for the Greater Good
Playing through August 23rd. REGISTER NOW:
http://go.thetruthaboutvaccines.online/?a_aid=550a00bc0bfa1&a_bid=9dd5b084
Help us get this information out to the masses. Piss off TPTB and join as an affiliate:
https://affiliates.thetruthaboutvaccines.com/affiliates/signup.php?a_aid=550a00bc0bfa1
Want to see how REALLY dangerous the dTap vaccines are?
Page 11 of the Tripedia Package insert. Adverse Reactions & Adverse Events. *** Adverse events reported during *post-approval* use of Tripedia vaccine include idiopathic thrombocytopenic purpura, SIDS, anaphylactic reaction, cellulitis, AUTISM, convulsion/grand mal convulsion, encephalopathy, hypotonia, neuropathy, somnolence and apnea. Events were included in this list because of the seriousness or frequency of reporting. Because these events are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequencies or to establish a causal relationship to components of Tripedia vaccine.2
The original package insert may have disappeared off of the FDA & govt sites, but several smart folks saved it.
http://www.getcancercure.com/wp-content/plugins/download-attachments/includes/download.php?id=2038
Archived: ucm101580.pdf
https://vaccines.procon.org/sourcefiles/DTaP_Tripedia.pdf
http://www.whale.to/vaccine/DTap.pdf
-----
The Truth About Vaccines (TTAV):
Register to watch FREE
Trailer Page - TTAV Re-Launch Aug 2017
Article - "Vaccine Schedule" - TTAV Re-Launch Aug 2017
Article - "Herd Immunity" - TTAV Re-Launch Aug 2017
Article - "Vaccines & Autism" - TTAV Re-Launch Aug 2017
TTAV Affiliate Signup
Vaccines Revealed:
VR Evergreen Registration
VR Evergreen Affiliate
Evergreen Sales Page
-----
Pennsylvania:
Statement of Exemption to Immunization Law
Commonwealth of Pennsylvania
Medical exemption - when the physical condition of the child is such that immunization would endanger life or health. (Requires Physician's signature.)
Religious exemption –when the parent/guardian adheres to a religious belief whose teachings are opposed to such immunizations. (Requires parent/guardian signature.)
Statement of Exemption to Immunization Law:
Commonwealth of Pennsylvania
http://www.woodmed.com/html/Exemption_to_Immunization_Law.html
http://experimentalvaccines.org/wp-content/uploads/2013/06/Pennsylvania-Statement-of-Exemption-to-Immunization-Form.pdf
Statement of Exemption to Immunization Law:
Commonwealth of Pennsylvania
http://www.pbsd.k12.pa.us/Downloads/Religious%20Exemption%20Form2.pdf
[PDF] immunization exemption letter - pamfa
http://pamfa.org/wp-content/uploads/2017/04/SAMPLE-EXEMPTION-LETTER.pdf
[DOCX] immunization exemption letter - pamfa
http://pamfa.org/wp-content/uploads/2017/04/SAMPLE-EXEMPTION-LETTER.docx
-----
Louisiana:
STATEMENT OF EXEMPTION FROM IMMUNIZATIONS
Louisiana Dept. of Education
https://www.louisianabelieves.com/docs/default-source/early-childhood/statement-of-exemption-from-immunizations.pdf
-----
Maryland:
VACCINATION EXEMPTION PURSUANT TO THE MARYLAND STATUTE § 7-403
§7-403 (b) Exception.
(1) Unless the Secretary of Health and Mental Hygiene declares an emergency or an epidemic of disease, a child whose parent or guardian objects to immunization on the ground that it conflicts with the parent’s or guardian’s bona fide religious beliefs and practices may not be required to present a physician’s certificate of immunization in order to be admitted to school
(2) The Secretary of Health and Mental Hygiene shall adopt rules and regulations for religious exemptions under this subsection.
____________________________________________________________
VACCINE EXEMPTION FORM
http://www.dswashington.org/files/dswashington/Dateien/b2013/Verwaltung/12_04_11_Vaccination_Exemption.pdf
http://www.brainfoodcookbook.com/ExemptionVacLib-Maryland.pdf
http://experimentalvaccines.org/vaccine-exemption-forms/maryland/
Or you can sign off at the bottom of the Maryland Certificate of Immunization.
https://www.barrie.org/uploaded/Camp_Files/ImmunizationCertificate.pdf
 |
| https://www.barrie.org/uploaded/Camp_Files/ImmunizationCertificate.pdf |
-----
The Truth About Vaccines Docu-series re-launch Ep 3 airs tonight.
3.August 19 - Episode 3: An Analysis of the MMR & DTaP Vaccines & Vaccinating for the Greater Good
Playing through August 23rd. REGISTER NOW:
http://go.thetruthaboutvaccines.online/?a_aid=550a00bc0bfa1&a_bid=9dd5b084
Help us get this information out to the masses. Piss off TPTB and join as an affiliate:
https://affiliates.thetruthaboutvaccines.com/affiliates/signup.php?a_aid=550a00bc0bfa1
Want to see how REALLY dangerous the dTap vaccines are?
Page 11 of the Tripedia Package insert. Adverse Reactions & Adverse Events. *** Adverse events reported during *post-approval* use of Tripedia vaccine include idiopathic thrombocytopenic purpura, SIDS, anaphylactic reaction, cellulitis, AUTISM, convulsion/grand mal convulsion, encephalopathy, hypotonia, neuropathy, somnolence and apnea. Events were included in this list because of the seriousness or frequency of reporting. Because these events are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequencies or to establish a causal relationship to components of Tripedia vaccine.2
The original package insert may have disappeared off of the FDA & govt sites, but several smart folks saved it.
http://www.getcancercure.com/wp-content/plugins/download-attachments/includes/download.php?id=2038
Archived: ucm101580.pdf
https://vaccines.procon.org/sourcefiles/DTaP_Tripedia.pdf
http://www.whale.to/vaccine/DTap.pdf
-----
The Truth About Vaccines (TTAV):
Register to watch FREE
Trailer Page - TTAV Re-Launch Aug 2017
Article - "Vaccine Schedule" - TTAV Re-Launch Aug 2017
Article - "Herd Immunity" - TTAV Re-Launch Aug 2017
Article - "Vaccines & Autism" - TTAV Re-Launch Aug 2017
TTAV Affiliate Signup
Vaccines Revealed:
VR Evergreen Registration
VR Evergreen Affiliate
Evergreen Sales Page
Friday, August 18, 2017
Vaccine Exemption Forms for Kentucky, Tennessee, Illinois, Indiana, North Carolina, and Virginia
These forms should ALL be downloaded, saved shared, even if one is from a different state, because you never know who may end up needing them, especially if they disappear from the internet.
I will come back and add the rest of the forms for these states, as there are usually more than one, but at least want to get these links out right now.
Exemption Forms for the following states...
Kentucky:
[PDF] COMMONWEALTH OF KENTUCKY CERTIFICATE OF RELIGIOUS EXEMPTION
https://web.archive.org/web/20170701235744/http://education.ky.gov/districts/SHS/Documents/ReligiousCertificateRev082010.pdf
[PDF] CERTIFICATE OF MEDICAL EXEMPTION
https://www.jefferson.kyschools.us/file/9390
[PDF] VACCINATION EXEMPTION PURSUANT TO THE KENTUCKY REVISED STATUES (KRS) § 158.035
http://wakeupgethealthy.com/wp-content/uploads/2018/10/ky-religious-exemption-affidavit.pdf
[PDF] IMM-2 Immunization Religious Exemption Form
http://www.warrencountyschools.org/userfiles/1382/Student%20Services/Religious%20Exemption.pdf
[PDF] REQUEST FOR RELIGIOUS EXEMPTION
http://wakeupgethealthy.com/wp-content/uploads/2018/10/VACEXMPT.pdf
Kentucky - The original title of the page - Experimental Vaccines
http://experimentalvaccines.org/vaccine-exemption-forms/kentucky/
Tennessee:
[PDF] MODEL FORM Religious Exemption from Vaccination(s)
https://www.ccsk12.com/images/uploads/documents/Religious_Immun_Exemp.pdf
https://web.archive.org/web/20160221212313/http://web.knoxnews.com/pdf/120708vax-religious-exempt.pdf
[PDF] WCS Immunization Religious Exemption Affidavit - Williamson County ...
WILLIAMSON COUNTY SCHOOLS IMMUNIZATION EXEMPTION AFFIDAVIT
https://www.wcs.edu//pdf/health/Religious-Exemption-Affidavit.pdf
Illinois:
Illinois Religious Exemption Letter - Scribd
https://www.scribd.com/document/20732332/Illinois-Religious-Exemption-Letter
[PDF] Certificate of Religious Exemption Form - IDPH
http://www.dph.illinois.gov/sites/default/files/forms/religious-exemption-form-081815-040816.pdf
http://idph.prod.acquia-sites.com/sites/default/files/forms/religious-exemption-form-081815-040816.pdf
http://www.regardingcaroline.com/exemptionletter.html
C P S Chicago Public Schools.
125 S. Clark. Chicago, Illinois 60603.
PHYSICAL EXAMINATION and/or IMMUNIZATION WAIVER FORM
http://www.nettelhorst.org/pdf/forms/OR_CPS_Physical_Exam_Immunization_Waiver.pdf
* State specific religious belief that forbids immunizations below
Grab a text from some of the VacLib archived versions below, and be sure to also cite the statute/law.
-----
From VacLib Illinois page (archived version):
Sample Religious Vaccination Exemption
http://www.vaccineawareness.org/information/Sample...
Illinois Religious exemption letter.doc
http://www.vaclib.org/letters/Illinois%20Religious%20exemption%20letter.doc
IllinoisReligiousexemptionletter.doc (larger font)
http://www.vaclib.org/letters/IllinoisReligiousexemptionletter.doc
VaccineTruth.net/letters/Illinois Catholic Religious Exemption letter.doc
http://www.vaclib.org/letters/Illinois%20Catholic%20Religious%20Exemption%20letter.doc
VaccineTruth.net/letters/Illinois Catholic religious exemption for VARIVAX.doc
http://vaclib.org/letters/Illinois%20Catholic%20religious%20exemption%20for%20VARIVAX.doc
-----
Indiana:
NOBLESVILLE SCHOOLS
18025 River Road • Noblesville • IN 46062
[PDF] Immunization Religious Exemption .pdf - Noblesville Schools
https://www.noblesvilleschools.org/site/handlers/filedownload.ashx?moduleinstanceid=7336&dataid=2477&FileName=Immunization%20Religious%20Exemption%20.pdf
[PDF] Religious Exemption Letter - Noblesville Schools
https://www.noblesvilleschools.org/cms/lib07/IN01906676/Centricity/Domain/222/ReligiousExemptionLetter.pdf
VACCINE MEDICAL EXEMPTION for Providers
State Form 54648 (4-11)
Indiana State Department of Health, Immunization Division
http://www.doe.in.gov/sites/default/files/health/medical-exemption-form-providers.pdf
(.doc) VaccineTruth.net/letters/ExemptionVacLib-Indiana.doc.
http://vaccinetruth.net/letters/ExemptionVacLib-Indiana.doc
[DOC] religious exemption letter
https://www.ltschools.org/MediaLibraries/ltschools.org/Documents/District/Health/Religious-Exemption_2.doc
STATEMENT OF IMMUNIZATION HISTORY;. WAIVER; RULES - INDIANA CODE §20-34-4-5. (a) Each school shall require the parent of a student who has enrolled in the school to furnish not later than the first day of school a written statement of the student's immunization, accompanied by the physician's certificates or other documentation, unless a written statement of this nature is on file with the school ...
[PDF] Indiana Religious Immunization Exemption Request Form
http://experimentalvaccines.org/wp-content/uploads/2013/06/Indiana-Immunization-Religious-Exemption-Request-Form.pdf
As a parent/guardian having control of and responsibility for. , a minor enrolled in the. school, I request that said minor be exempt from the vaccination and immunization requirements on religious grounds in accordance with the Indiana Code 20-8.1-7-9.5 section 2A ...
[PDF] Indiana Religious Vaccine Exemption Form - Experimental Vaccines
http://experimentalvaccines.org/wp-content/uploads/2013/06/Indiana-Religious-Vaccine-Exemption-Form.pdf
North Carolina:
[PDF] NORTH CAROLINA IMMUNIZATION LAW RELIGIOUS EXEMPTION
http://www.langtreecharter.org/wp-content/uploads/2015/04/NC-Exemption.pdf
NORTH CAROLINA IMMUNIZATION LAW
RELIGIOUS EXEMPTION
NORTH CAROLINA GENERAL STATUTE 130A-157
[PDF] North Carolina Immunization Religious Exemption Form
https://www.cabarruscharter.org/pdf/NC-Exemption.pdf
Virginia:
[PDF] Certificate of Religious Exemption - Commonwealth of Virginia
http://www.doe.virginia.gov/support/health_medical/certificate_religious_exemption.pdf
-----
The Truth About Vaccines (TTAV):
Register to watch FREE
Trailer Page - TTAV Re-Launch Aug 2017
Article - "Vaccine Schedule" - TTAV Re-Launch Aug 2017
Article - "Herd Immunity" - TTAV Re-Launch Aug 2017
Article - "Vaccines & Autism" - TTAV Re-Launch Aug 2017
TTAV Affiliate Signup
Vaccines Revealed:
VR Evergreen Registration
VR Evergreen Affiliate
Evergreen Sales Page
I will come back and add the rest of the forms for these states, as there are usually more than one, but at least want to get these links out right now.
Exemption Forms for the following states...
Kentucky:
[PDF] COMMONWEALTH OF KENTUCKY CERTIFICATE OF RELIGIOUS EXEMPTION
https://web.archive.org/web/20170701235744/http://education.ky.gov/districts/SHS/Documents/ReligiousCertificateRev082010.pdf
[PDF] CERTIFICATE OF MEDICAL EXEMPTION
https://www.jefferson.kyschools.us/file/9390
[PDF] VACCINATION EXEMPTION PURSUANT TO THE KENTUCKY REVISED STATUES (KRS) § 158.035
http://wakeupgethealthy.com/wp-content/uploads/2018/10/ky-religious-exemption-affidavit.pdf
[PDF] IMM-2 Immunization Religious Exemption Form
http://www.warrencountyschools.org/userfiles/1382/Student%20Services/Religious%20Exemption.pdf
[PDF] REQUEST FOR RELIGIOUS EXEMPTION
http://wakeupgethealthy.com/wp-content/uploads/2018/10/VACEXMPT.pdf
Kentucky - The original title of the page - Experimental Vaccines
http://experimentalvaccines.org/vaccine-exemption-forms/kentucky/
Tennessee:
[PDF] MODEL FORM Religious Exemption from Vaccination(s)
https://www.ccsk12.com/images/uploads/documents/Religious_Immun_Exemp.pdf
https://web.archive.org/web/20160221212313/http://web.knoxnews.com/pdf/120708vax-religious-exempt.pdf
[PDF] WCS Immunization Religious Exemption Affidavit - Williamson County ...
WILLIAMSON COUNTY SCHOOLS IMMUNIZATION EXEMPTION AFFIDAVIT
https://www.wcs.edu//pdf/health/Religious-Exemption-Affidavit.pdf
Mirror: http://wakeupgethealthy.com/wp-content/uploads/2018/10/WCS-Immunization-Religious-Exemption-Affidavit.pdf
Exemption Requests Information: https://www.wcs.edu//pdf/health/Religious-Exemption-Information.pdf
[PDF] vaccination(s) refusal due to personal religious beliefs - Knox County Schools
http://www.knoxschools.org/site/handlers/filedownload.ashx?moduleinstanceid=12500&dataid=3378&FileName=religious%20exemption%20letter.pdf
[PDF] IMMUNIZATION EXEMPTION FORM Medical Exemption Religious Exemption ...
THE UNIVERSITY OF TENNESSEE AT MARTIN STUDENT HEALTH AND COUNSELING SERVICES
https://uthsc.edu/health-services/documents/immunization-exemption-form.pdf
[PDF] Religious Exemption - UTM.edu
https://www.utm.edu/departments/shcs/_pdfs/Religious%20Exemption.pdf
Exemption Requests Information: https://www.wcs.edu//pdf/health/Religious-Exemption-Information.pdf
[PDF] vaccination(s) refusal due to personal religious beliefs - Knox County Schools
http://www.knoxschools.org/site/handlers/filedownload.ashx?moduleinstanceid=12500&dataid=3378&FileName=religious%20exemption%20letter.pdf
[PDF] IMMUNIZATION EXEMPTION FORM Medical Exemption Religious Exemption ...
THE UNIVERSITY OF TENNESSEE AT MARTIN STUDENT HEALTH AND COUNSELING SERVICES
https://uthsc.edu/health-services/documents/immunization-exemption-form.pdf
[PDF] Religious Exemption - UTM.edu
https://www.utm.edu/departments/shcs/_pdfs/Religious%20Exemption.pdf
Illinois:
Illinois Religious Exemption Letter - Scribd
https://www.scribd.com/document/20732332/Illinois-Religious-Exemption-Letter
[PDF] Certificate of Religious Exemption Form - IDPH
http://www.dph.illinois.gov/sites/default/files/forms/religious-exemption-form-081815-040816.pdf
http://idph.prod.acquia-sites.com/sites/default/files/forms/religious-exemption-form-081815-040816.pdf
http://www.regardingcaroline.com/exemptionletter.html
C P S Chicago Public Schools.
125 S. Clark. Chicago, Illinois 60603.
PHYSICAL EXAMINATION and/or IMMUNIZATION WAIVER FORM
http://www.nettelhorst.org/pdf/forms/OR_CPS_Physical_Exam_Immunization_Waiver.pdf
* State specific religious belief that forbids immunizations below
Grab a text from some of the VacLib archived versions below, and be sure to also cite the statute/law.
-----
From VacLib Illinois page (archived version):
Sample Religious Vaccination Exemption
http://www.vaccineawareness.org/information/Sample...
Illinois Religious exemption letter.doc
http://www.vaclib.org/letters/Illinois%20Religious%20exemption%20letter.doc
IllinoisReligiousexemptionletter.doc (larger font)
http://www.vaclib.org/letters/IllinoisReligiousexemptionletter.doc
VaccineTruth.net/letters/Illinois Catholic Religious Exemption letter.doc
http://www.vaclib.org/letters/Illinois%20Catholic%20Religious%20Exemption%20letter.doc
VaccineTruth.net/letters/Illinois Catholic religious exemption for VARIVAX.doc
http://vaclib.org/letters/Illinois%20Catholic%20religious%20exemption%20for%20VARIVAX.doc
-----
Indiana:
NOBLESVILLE SCHOOLS
18025 River Road • Noblesville • IN 46062
[PDF] Immunization Religious Exemption .pdf - Noblesville Schools
https://www.noblesvilleschools.org/site/handlers/filedownload.ashx?moduleinstanceid=7336&dataid=2477&FileName=Immunization%20Religious%20Exemption%20.pdf
[PDF] Religious Exemption Letter - Noblesville Schools
https://www.noblesvilleschools.org/cms/lib07/IN01906676/Centricity/Domain/222/ReligiousExemptionLetter.pdf
VACCINE MEDICAL EXEMPTION for Providers
State Form 54648 (4-11)
Indiana State Department of Health, Immunization Division
http://www.doe.in.gov/sites/default/files/health/medical-exemption-form-providers.pdf
(.doc) VaccineTruth.net/letters/ExemptionVacLib-Indiana.doc.
http://vaccinetruth.net/letters/ExemptionVacLib-Indiana.doc
[DOC] religious exemption letter
https://www.ltschools.org/MediaLibraries/ltschools.org/Documents/District/Health/Religious-Exemption_2.doc
STATEMENT OF IMMUNIZATION HISTORY;. WAIVER; RULES - INDIANA CODE §20-34-4-5. (a) Each school shall require the parent of a student who has enrolled in the school to furnish not later than the first day of school a written statement of the student's immunization, accompanied by the physician's certificates or other documentation, unless a written statement of this nature is on file with the school ...
[PDF] Indiana Religious Immunization Exemption Request Form
http://experimentalvaccines.org/wp-content/uploads/2013/06/Indiana-Immunization-Religious-Exemption-Request-Form.pdf
As a parent/guardian having control of and responsibility for. , a minor enrolled in the. school, I request that said minor be exempt from the vaccination and immunization requirements on religious grounds in accordance with the Indiana Code 20-8.1-7-9.5 section 2A ...
[PDF] Indiana Religious Vaccine Exemption Form - Experimental Vaccines
http://experimentalvaccines.org/wp-content/uploads/2013/06/Indiana-Religious-Vaccine-Exemption-Form.pdf
North Carolina:
[PDF] NORTH CAROLINA IMMUNIZATION LAW RELIGIOUS EXEMPTION
http://www.langtreecharter.org/wp-content/uploads/2015/04/NC-Exemption.pdf
NORTH CAROLINA IMMUNIZATION LAW
RELIGIOUS EXEMPTION
NORTH CAROLINA GENERAL STATUTE 130A-157
[PDF] North Carolina Immunization Religious Exemption Form
https://www.cabarruscharter.org/pdf/NC-Exemption.pdf
Virginia:
[PDF] Certificate of Religious Exemption - Commonwealth of Virginia
http://www.doe.virginia.gov/support/health_medical/certificate_religious_exemption.pdf
-----
The Truth About Vaccines (TTAV):
Register to watch FREE
Trailer Page - TTAV Re-Launch Aug 2017
Article - "Vaccine Schedule" - TTAV Re-Launch Aug 2017
Article - "Herd Immunity" - TTAV Re-Launch Aug 2017
Article - "Vaccines & Autism" - TTAV Re-Launch Aug 2017
TTAV Affiliate Signup
Vaccines Revealed:
VR Evergreen Registration
VR Evergreen Affiliate
Evergreen Sales Page
Sunday, August 13, 2017
MessiahMews Blogs: New Exemption Forms for Various States
MessiahMews Blogs: New Exemption Forms for Various States: Every now and then, I'll go on a search spree, and find updated and/or new exemption forms online...
--
REPOST and EDITED: Added South Carolina, Georgia, and Montana, and replaced TWO links from CO, which had changed since the original post. Beware of that, it happens, as previously warned. Also added Arizona with a warning about their current incriminating exemption forms, with some options in place. Be sure to share with folks from these states.
-----
--
REPOST and EDITED: Added South Carolina, Georgia, and Montana, and replaced TWO links from CO, which had changed since the original post. Beware of that, it happens, as previously warned. Also added Arizona with a warning about their current incriminating exemption forms, with some options in place. Be sure to share with folks from these states.
 |
| Our RIGHT to say NO, & to protect our children, pets & ourselves from mandated poisons from known satanist murderers. We decline any and all offers to CONtract with known satanists & their evil CORPORATIONS. |
-----
Tuesday, April 18, 2017
Get vaccinated contest????
Ohio Advocates for Medical Freedom
Get vaccinated contest????
That's what is happening at Meigs Local School. They have entered a competition with the southern and eastern school districts to see who can get the most kids vaccinated. There is a prize involved and “bragging rights”.
It leaves us wondering, is there informed consent involved when coercion and persuasion are involved? Do these districts understand that vaccinations are biological products with known risk, including death? Are they providing information on exemptions per ORC 3313.671 that allows for vaccination exemption for reason of conscience, including religious, and medical?
http://codes.ohio.gov/orc/3313.671
Folks, now is not the time to sit on your hands regarding your rights. If you don't speak up and start engaging your community in an honest balanced conversation, you will soon find your rights slipping away.
It's time we start calling out our districts that are engaging in unacceptable behavior.
Please take some time this week to call this district and let them know your personal story and what lead you to be vaccine risk aware. Because they don't know, until they know.
Meigs Local School District
Phone: 740-992-2153
http://www.ml.k12.oh.us/
***the photo has been edited to add emphasis to the contest information.
-----
There's No Need To Fear! Ohio Exemption Forms Are Here!!
LEGAL IMMUNIZATION EXEMPTION. Per OHIO STATUTE 3313.671 (EXEMPTIONS)
[PDF] Ohio Immunization Exemption Form
http://www.pedsofcincy.com/forms/ohioLegalExemptionForm.pdf
GALION CITY SCHOOL DISTRICT
[PDF] State of Ohio Legal Immunization Exemption Per Ohio Statute ...
http://www.galionschools.org/upload/documents/immunizationexemption.pdf
* The form is generic, so any school can accept it.
Ohio Immunization Exemption Form | Symmes Chiropractic Center
The State of Ohio allows parents/guardians to exempt their child from "mandatory" vaccinations for philosophical or religious convictions. This form will enable the parent to clearly state to the school or institution the revised Ohio code legally allowing a child not to be vaccinated. Note, privatized institutions may not except this form, due to the fact they have the ability to create their own internal regulations.
http://symmeschiro.com/files/OH%20Immunization%20Exemption.pdf
School Exemptions - Ohio Advocates for Medical Freedom
School Exemption Form (K-12)
Medical exemptions are typically completed by a physician and submitted to the school district. However, this form used by one of our member physicians, covers both religious and philosophical exemptions to vaccination and does not include any other unnecessary details. Here are the PDF and jpg versions:
ohio vaccination waiver_exemption (PDF)
https://ohioamf.org/wp-content/uploads/2016/07/ohio-vaccination-waiver_exemption-8_2013.pdf
ParentsAgainstMandatoryVaccines - Vaccination Exemption Form - Ohio
https://parentsagainstmandatoryvaccines.wikispaces.com/file/view/OH_Exemption_Form.pdf/294244252/OH_Exemption_Form.pdf
ParentsAgainstMandatoryVaccines - Vaccination Exemption Form - Ohio
OH Exemption Form.doc
https://parentsagainstmandatoryvaccines.wikispaces.com/file/view/OH+Exemption+Form.doc
Neola Forms Immunization Exemptions - Ohio
https://www.google.com/#q=Neola+Forms+Immunization+Exemptions
https://www.google.com/#q=Neola+Forms+Immunization+Exemptions+Form+5320f2
[PDF] Immunization Exemption Form - Neola
http://www.neola.com/uacsd-oh/search/forms/fm5320F2.pdf
[PDF] IMMUNIZATION EXEMPTION FORM Ohio Revised Code ... - Neola
http://neola.com/triad-oh/search/forms/fm5320F2.pdf
[PDF] Departments Health Services Immunization Exemption form
http://www.dps.k12.oh.us/documents/contentdocuments/doc_23_5_4.pdf
-----
Get vaccinated contest????
That's what is happening at Meigs Local School. They have entered a competition with the southern and eastern school districts to see who can get the most kids vaccinated. There is a prize involved and “bragging rights”.
It leaves us wondering, is there informed consent involved when coercion and persuasion are involved? Do these districts understand that vaccinations are biological products with known risk, including death? Are they providing information on exemptions per ORC 3313.671 that allows for vaccination exemption for reason of conscience, including religious, and medical?
http://codes.ohio.gov/orc/3313.671
Folks, now is not the time to sit on your hands regarding your rights. If you don't speak up and start engaging your community in an honest balanced conversation, you will soon find your rights slipping away.
It's time we start calling out our districts that are engaging in unacceptable behavior.
Please take some time this week to call this district and let them know your personal story and what lead you to be vaccine risk aware. Because they don't know, until they know.
Meigs Local School District
Phone: 740-992-2153
http://www.ml.k12.oh.us/
***the photo has been edited to add emphasis to the contest information.
-----
There's No Need To Fear! Ohio Exemption Forms Are Here!!
LEGAL IMMUNIZATION EXEMPTION. Per OHIO STATUTE 3313.671 (EXEMPTIONS)
[PDF] Ohio Immunization Exemption Form
http://www.pedsofcincy.com/forms/ohioLegalExemptionForm.pdf
GALION CITY SCHOOL DISTRICT
[PDF] State of Ohio Legal Immunization Exemption Per Ohio Statute ...
http://www.galionschools.org/upload/documents/immunizationexemption.pdf
* The form is generic, so any school can accept it.
Ohio Immunization Exemption Form | Symmes Chiropractic Center
The State of Ohio allows parents/guardians to exempt their child from "mandatory" vaccinations for philosophical or religious convictions. This form will enable the parent to clearly state to the school or institution the revised Ohio code legally allowing a child not to be vaccinated. Note, privatized institutions may not except this form, due to the fact they have the ability to create their own internal regulations.
http://symmeschiro.com/files/OH%20Immunization%20Exemption.pdf
School Exemptions - Ohio Advocates for Medical Freedom
School Exemption Form (K-12)
Medical exemptions are typically completed by a physician and submitted to the school district. However, this form used by one of our member physicians, covers both religious and philosophical exemptions to vaccination and does not include any other unnecessary details. Here are the PDF and jpg versions:
ohio vaccination waiver_exemption (PDF)
https://ohioamf.org/wp-content/uploads/2016/07/ohio-vaccination-waiver_exemption-8_2013.pdf
ParentsAgainstMandatoryVaccines - Vaccination Exemption Form - Ohio
https://parentsagainstmandatoryvaccines.wikispaces.com/file/view/OH_Exemption_Form.pdf/294244252/OH_Exemption_Form.pdf
ParentsAgainstMandatoryVaccines - Vaccination Exemption Form - Ohio
OH Exemption Form.doc
https://parentsagainstmandatoryvaccines.wikispaces.com/file/view/OH+Exemption+Form.doc
Neola Forms Immunization Exemptions - Ohio
https://www.google.com/#q=Neola+Forms+Immunization+Exemptions
https://www.google.com/#q=Neola+Forms+Immunization+Exemptions+Form+5320f2
[PDF] Immunization Exemption Form - Neola
http://www.neola.com/uacsd-oh/search/forms/fm5320F2.pdf
[PDF] IMMUNIZATION EXEMPTION FORM Ohio Revised Code ... - Neola
http://neola.com/triad-oh/search/forms/fm5320F2.pdf
[PDF] Departments Health Services Immunization Exemption form
http://www.dps.k12.oh.us/documents/contentdocuments/doc_23_5_4.pdf
-----
Thursday, March 23, 2017
New Exemption Forms for Various States
Every now and then, I'll go on a search spree, and find updated and/or new exemption forms online.
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.
Oklahoma:
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
https://www.ok.gov/health2/documents/IMM_School_ODH_216a_Certificate_of_Exemption.pdf
[PDF] certificate of exemption - Epic Charter Schools
http://epiccharterschools.org/document/immunization-exemption
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.
Delaware:
http://delcode.delaware.gov/title14/c001/sc02/index.shtml#P227_51758
http://vaccines.procon.org/sourcefiles/delaware_vaccine_law.pdf
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
http://www.dhss.delaware.gov/dph/hsp/files/olpprelexempt.pdf
[PDF] Notarized Affidavit of Religious Belief
http://www.doe.k12.de.us/cms/lib09/DE01922744/Centricity/Domain/150/Immunization%20-%20Notarized%20Affidavit%20of%20Religious%20Belief.pdf
[PDF] Affidavit for Religious Exemption from Vaccination Requirement
https://www.wmsde.org/uploaded/Community/Vaccination_affidavit_8-201541984.pdf
[PDF] Affidavit for Religious Exemption from Lead Testing Requirement
https://www.wmsde.org/uploaded/Community/lead_exemption30149.pdf
[PDF] Delaware Religious Belief Affidavit Vaccine Exemption Form
http://experimentalvaccines.org/wp-content/uploads/2013/05/Delaware-Religious-Belief-Affidavit-Vaccine-Exemption-Form.pdf
[PDF] Immunization - School Vaccination Medical Exemption Form
http://www.doe.k12.de.us/cms/lib09/DE01922744/Centricity/Domain/150/Immunization%20-%20School%20Vaccination%20Medical%20Exemption%20Form.pdf
[PDF] University of Delaware Immunization and History Form
http://www.brandywinepediatrics.com/admin/uploads/UDImmunizationInformationFormpdf.pdf
Maine:
Maine Religious and Philosophical Belief Exemption Form
IMMUNIZATION EXEMPTION FORM
http://experimentalvaccines.org/wp-content/uploads/2013/06/Maine-Religious-and-Philosophical-Belief-Exemption-Form.pdf
Maine Regional School Unit 21
Arundel, Kennebunk, Kennebunkport , Maine
Immunization Exemption Form
http://experimentalvaccines.org/wp-content/uploads/2013/06/Maine-Regional-School-Unit-21-Immunization-Exemption-Form.pdf
RSU No. 5
Durham – Freeport - Pownal
Maine Immunization Exemption
http://www.rsu5.org/userfiles/-4/my%20files/exemption%20formfinal.pdf?id=173
MSAD 49
Fairfield - Albion - Benton - Clinton
District Medical Immunization Exemption Form
MEDICAL IMMUNIZATION EXEMPTION FORM
https://core-docs.s3.amazonaws.com/documents/asset/uploaded_file/525002/Immunization_Exemption-_Medical.pdf
MSAD 49
Fairfield - Albion - Benton - Clinton
District Medical Philosophical and Religious Immunization Exemption Form
PHILOSOPHICAL/RELIGIOUS IMMUNIZATION EXEMPTION FORM
https://core-docs.s3.amazonaws.com/documents/asset/uploaded_file/525005/Immunization_Exemption-_Philosophical_Religious.pdf
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]
https://sites.google.com/a/scarboroughschools.org/sps/central-office/health-services/health-services-documents/Immunizations-Exemption-Form.docx?attredirects=0&d=1
https://sites.google.com/a/scarboroughschools.org/sps/central-office/health-services/health-forms/Immunizations-Exemption-Form.docx?attredirects=0&d=1
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.
https://usm.maine.edu/sites/default/files/University%20Health%20and%20Counseling%20Services/Objection%20letter.pdf
University of Maine at Augusta Vaccine Waiver Form
http://experimentalvaccines.org/wp-content/uploads/2013/06/University-of-Maine-at-Augusta-Vaccine-Waiver-Form.pdf
[DOC] My SMCC - Southern Maine Community College
*WAIVER SECTION* Page 2
https://my.smccme.edu/ICS/icsfs/hImmunization_Form.pdf?target=59cd670e-01cf-42fc-bdb7-865a4e939896
[PDF] Immunization Waiver Form - University of Maine at Augusta
https://www.uma.edu/directory/wp-content/uploads/sites/9/2017/04/Immunization-Waiver-Form.pdf
Colorado:
Immunization Non-Medical Exemption Form (Religious and Personal Belief)
https://www.colorado.gov/pacific/sites/default/files/Imm2_Non-Medical%20Exemption-English-0417.pdf
Immunization Medical Exemption Form
https://www.colorado.gov/pacific/sites/default/files/Imm_Medical-Exemption-English-0417.pdf
Other Languages Here:
https://www.colorado.gov/pacific/cdphe/vaccine-exemptions
NOTE: Colorado's forms are incriminating forms. The law allows you make your own statement.
-----
South Carolina:
South Carolina Certificate of Religious Exemption (From Immunization)
Religious Exemption form (DHEC form 1126)
http://www.vaclib.org/letters/DHEC-1126.pdf
http://experimentalvaccines.org/wp-content/uploads/2013/06/South-Carolina-Certificate-of-Religious-Immunization-Exemption.pdf
http://www.nvic.org/Vaccine-Laws/state-vaccine-requirements/northcarolina/south-carolina-religious-waiver.aspx
[The medical exemption] form is at the bottom of the DHEC 1148
http://www.vaclib.org/letters/DHEC-1148.PDF
http://experimentalvaccines.org/wp-content/uploads/2013/06/South-Carolina-Medical-Vaccine-Immunization-Exemption-Form.pdf
-----
Georgia:
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
https://wellness-chiropractic-center.com/misc/vacaffidavit.pdf?fref=gc
* Best form, works for any school.
]DOC] Form JGC-4 - Cobb County School District
http://www.cobbk12.org/centraloffice/adminrules/J/Form_JGC-4.docx
Atlanta Public Schools:
IMMUNIZATION REQUIREMENTS:
AFFIDAVIT OF RELIGIOUS OBJECTION
https://www.atlantapublicschools.us/cms/lib/GA01000924/Centricity/Domain/74/Religious%20Objection%20Affidavit%20-%20Immunizationsv2.pdf
ExemptionVacLib-Georgia.137130643.pdf
http://www.basicchiropractic.com/yahoo_site_admin/assets/docs/ExemptionVacLib-Georgia.137130643.pdf
AFFIDAVIT OF RELIGIOUS OBJECTION TO IMMUNIZATION
http://dph.georgia.gov/document/document/affidavit-religious-objection-immunization/download
-----
Montana:
[PDF] Religious Exemption Form - Dphhs
AFFIDAVIT OF EXEMPTION ON RELIGIOUS GROUNDS FROM MONTANA SCHOOL IMMUNIZATION LAW AND RULES
http://dphhs.mt.gov/Portals/85/publichealth/documents/Immunization/2017/ReligiousExemptionForm2015.pdf
Note: Above link was just replaced.
Extra Backup links:
[PDF] affidavit of exemption on religious grounds - Experimental Vaccines
Web Archives:
https://web.archive.org/web/20170201153713/http://www.dphhs.mt.gov/Portals/85/publichealth/documents/Immunization/Day%20Care/06_HES%20114%20Hib%20religious%20exemp.pdf
Archives Search:
https://web.archive.org/web/20170601000000*/http://www.dphhs.mt.gov/Portals/85/publichealth/documents/Immunization/Day%20Care/06_HES%20114%20Hib%20religious%20exemp.pdf
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)
http://experimentalvaccines.org/wp-content/uploads/2013/06/Montana-Medical-Vaccine-Exemption-Form-HES-101.pdf
[PDF] Medical Exemption Form - Dphhs
Medical Exemption Statement
https://dphhs.mt.gov/Portals/85/publichealth/documents/Immunization/2017/HES101AMedicalExpemptionForm2018_11_2018.pdf?ver=2018-11-27-084721-763
Daycare:
AFFIDAVIT of EXEMPTION FROM ADMINISTRATION of
HAEMOPHILUS INFLUENZAE TYPE b (Hib) on RELIGIOUS
GROUNDS FROM MONTANA
DAYCARE IMMUNIZATION RULES
https://dphhs.mt.gov/Portals/85/publichealth/documents/Immunization/06_HES114Hibreligiousexemp_2.pdf
Experimental Vaccines Link:
http://experimentalvaccines.org/wp-content/uploads/2013/06/Montana-Hib-Religious-Vaccine-Exemption-Form-HES-114.pdf
Montana Exemption Law
http://www.shotfreeinmontana.com/montana/mtlaw2001edit.htm
-----
Arizona:
Beware of the language of this current form...
This...
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:
https://azdhs.gov/documents/preparedness/epidemiology-disease-control/immunization/school-childcare/personal-belief-exemption.pdf
Formulario de Exención por Creencias Religiosas.pef
http://azdhs.gov/documents/preparedness/epidemiology-disease-control/immunization/school-childcare/religious-belief-exemption-espanol.pdf
--
Older NON-incrimating Forms:
From the older VacLib archived pages:
https://web.archive.org/web/20090211000957/http://vaccinetruth.net/exempt/arizona.htm
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)
(.pdf) http://www.azdhs.gov/als/forms/ccgh10.pdf
Schools:
Request for Exemption to Immunization Schools (English and Spanish)
(.pdf) http://azdhs.gov/phs/immun/pdf/school-exemption-form.pdf
Request for Exemption to Immunization - School (Spanish)
Sequoia Choice - AZ Distance Learning - Mesa, AZ. 85211-1405
(.pdf) http://scazdl.org/new/forms/waiver.pdf
ExemptionVacLib-Arizona.doc
(.doc) VaccineTruth.net/letters/ExemptionVacLib-Arizona.doc
If all else fails, and a parent is forced to sign an incriminating form, then write or sign name "Under Duress".
https://consciousawarenessforall.wordpress.com/2015/02/12/duress/
https://www.linkedin.com/pulse/how-sign-your-name-without-assuming-liability-cathy-bilsky
-----
The Truth About Vaccines (TTAV):
Register to watch FREE
Trailer Page - TTAV Re-Launch January 2018
Article - "Vaccine Schedule" - TTAV Re-Launch January 2018
Article - "Herd Immunity" - TTAV Re-Launch January 2018
Article - "Vaccines & Autism" - TTAV Re-Launch January 2018
TTAV Affiliate Signup
Vaccines Revealed:
VR Registration
VR Affiliate
-----
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.
Oklahoma:
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
https://www.ok.gov/health2/documents/IMM_School_ODH_216a_Certificate_of_Exemption.pdf
[PDF] certificate of exemption - Epic Charter Schools
http://epiccharterschools.org/document/immunization-exemption
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.
Delaware:
http://delcode.delaware.gov/title14/c001/sc02/index.shtml#P227_51758
http://vaccines.procon.org/sourcefiles/delaware_vaccine_law.pdf
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
http://www.dhss.delaware.gov/dph/hsp/files/olpprelexempt.pdf
[PDF] Notarized Affidavit of Religious Belief
http://www.doe.k12.de.us/cms/lib09/DE01922744/Centricity/Domain/150/Immunization%20-%20Notarized%20Affidavit%20of%20Religious%20Belief.pdf
[PDF] Affidavit for Religious Exemption from Vaccination Requirement
https://www.wmsde.org/uploaded/Community/Vaccination_affidavit_8-201541984.pdf
[PDF] Affidavit for Religious Exemption from Lead Testing Requirement
https://www.wmsde.org/uploaded/Community/lead_exemption30149.pdf
[PDF] Delaware Religious Belief Affidavit Vaccine Exemption Form
http://experimentalvaccines.org/wp-content/uploads/2013/05/Delaware-Religious-Belief-Affidavit-Vaccine-Exemption-Form.pdf
[PDF] Immunization - School Vaccination Medical Exemption Form
http://www.doe.k12.de.us/cms/lib09/DE01922744/Centricity/Domain/150/Immunization%20-%20School%20Vaccination%20Medical%20Exemption%20Form.pdf
[PDF] University of Delaware Immunization and History Form
http://www.brandywinepediatrics.com/admin/uploads/UDImmunizationInformationFormpdf.pdf
Maine:
Maine Religious and Philosophical Belief Exemption Form
IMMUNIZATION EXEMPTION FORM
http://experimentalvaccines.org/wp-content/uploads/2013/06/Maine-Religious-and-Philosophical-Belief-Exemption-Form.pdf
Maine Regional School Unit 21
Arundel, Kennebunk, Kennebunkport , Maine
Immunization Exemption Form
http://experimentalvaccines.org/wp-content/uploads/2013/06/Maine-Regional-School-Unit-21-Immunization-Exemption-Form.pdf
RSU No. 5
Durham – Freeport - Pownal
Maine Immunization Exemption
http://www.rsu5.org/userfiles/-4/my%20files/exemption%20formfinal.pdf?id=173
MSAD 49
Fairfield - Albion - Benton - Clinton
District Medical Immunization Exemption Form
MEDICAL IMMUNIZATION EXEMPTION FORM
https://core-docs.s3.amazonaws.com/documents/asset/uploaded_file/525002/Immunization_Exemption-_Medical.pdf
MSAD 49
Fairfield - Albion - Benton - Clinton
District Medical Philosophical and Religious Immunization Exemption Form
PHILOSOPHICAL/RELIGIOUS IMMUNIZATION EXEMPTION FORM
https://core-docs.s3.amazonaws.com/documents/asset/uploaded_file/525005/Immunization_Exemption-_Philosophical_Religious.pdf
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]
https://sites.google.com/a/scarboroughschools.org/sps/central-office/health-services/health-services-documents/Immunizations-Exemption-Form.docx?attredirects=0&d=1
https://sites.google.com/a/scarboroughschools.org/sps/central-office/health-services/health-forms/Immunizations-Exemption-Form.docx?attredirects=0&d=1
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.
https://usm.maine.edu/sites/default/files/University%20Health%20and%20Counseling%20Services/Objection%20letter.pdf
University of Maine at Augusta Vaccine Waiver Form
http://experimentalvaccines.org/wp-content/uploads/2013/06/University-of-Maine-at-Augusta-Vaccine-Waiver-Form.pdf
[DOC] My SMCC - Southern Maine Community College
*WAIVER SECTION* Page 2
https://my.smccme.edu/ICS/icsfs/hImmunization_Form.pdf?target=59cd670e-01cf-42fc-bdb7-865a4e939896
[PDF] Immunization Waiver Form - University of Maine at Augusta
https://www.uma.edu/directory/wp-content/uploads/sites/9/2017/04/Immunization-Waiver-Form.pdf
Colorado:
Immunization Non-Medical Exemption Form (Religious and Personal Belief)
https://www.colorado.gov/pacific/sites/default/files/Imm2_Non-Medical%20Exemption-English-0417.pdf
Immunization Medical Exemption Form
https://www.colorado.gov/pacific/sites/default/files/Imm_Medical-Exemption-English-0417.pdf
Other Languages Here:
https://www.colorado.gov/pacific/cdphe/vaccine-exemptions
-----
South Carolina:
South Carolina Certificate of Religious Exemption (From Immunization)
Religious Exemption form (DHEC form 1126)
http://www.vaclib.org/letters/DHEC-1126.pdf
http://experimentalvaccines.org/wp-content/uploads/2013/06/South-Carolina-Certificate-of-Religious-Immunization-Exemption.pdf
http://www.nvic.org/Vaccine-Laws/state-vaccine-requirements/northcarolina/south-carolina-religious-waiver.aspx
[The medical exemption] form is at the bottom of the DHEC 1148
http://www.vaclib.org/letters/DHEC-1148.PDF
http://experimentalvaccines.org/wp-content/uploads/2013/06/South-Carolina-Medical-Vaccine-Immunization-Exemption-Form.pdf
-----
Georgia:
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
https://wellness-chiropractic-center.com/misc/vacaffidavit.pdf?fref=gc
* Best form, works for any school.
]DOC] Form JGC-4 - Cobb County School District
http://www.cobbk12.org/centraloffice/adminrules/J/Form_JGC-4.docx
Atlanta Public Schools:
IMMUNIZATION REQUIREMENTS:
AFFIDAVIT OF RELIGIOUS OBJECTION
https://www.atlantapublicschools.us/cms/lib/GA01000924/Centricity/Domain/74/Religious%20Objection%20Affidavit%20-%20Immunizationsv2.pdf
ExemptionVacLib-Georgia.137130643.pdf
http://www.basicchiropractic.com/yahoo_site_admin/assets/docs/ExemptionVacLib-Georgia.137130643.pdf
AFFIDAVIT OF RELIGIOUS OBJECTION TO IMMUNIZATION
http://dph.georgia.gov/document/document/affidavit-religious-objection-immunization/download
-----
Montana:
[PDF] Religious Exemption Form - Dphhs
AFFIDAVIT OF EXEMPTION ON RELIGIOUS GROUNDS FROM MONTANA SCHOOL IMMUNIZATION LAW AND RULES
http://dphhs.mt.gov/Portals/85/publichealth/documents/Immunization/2017/ReligiousExemptionForm2015.pdf
Note: Above link was just replaced.
Extra Backup links:
[PDF] affidavit of exemption on religious grounds - Experimental Vaccines
Web Archives:
https://web.archive.org/web/20170201153713/http://www.dphhs.mt.gov/Portals/85/publichealth/documents/Immunization/Day%20Care/06_HES%20114%20Hib%20religious%20exemp.pdf
Archives Search:
https://web.archive.org/web/20170601000000*/http://www.dphhs.mt.gov/Portals/85/publichealth/documents/Immunization/Day%20Care/06_HES%20114%20Hib%20religious%20exemp.pdf
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)
http://experimentalvaccines.org/wp-content/uploads/2013/06/Montana-Medical-Vaccine-Exemption-Form-HES-101.pdf
[PDF] Medical Exemption Form - Dphhs
Medical Exemption Statement
https://dphhs.mt.gov/Portals/85/publichealth/documents/Immunization/2017/HES101AMedicalExpemptionForm2018_11_2018.pdf?ver=2018-11-27-084721-763
Daycare:
AFFIDAVIT of EXEMPTION FROM ADMINISTRATION of
HAEMOPHILUS INFLUENZAE TYPE b (Hib) on RELIGIOUS
GROUNDS FROM MONTANA
DAYCARE IMMUNIZATION RULES
https://dphhs.mt.gov/Portals/85/publichealth/documents/Immunization/06_HES114Hibreligiousexemp_2.pdf
Experimental Vaccines Link:
http://experimentalvaccines.org/wp-content/uploads/2013/06/Montana-Hib-Religious-Vaccine-Exemption-Form-HES-114.pdf
Montana Exemption Law
http://www.shotfreeinmontana.com/montana/mtlaw2001edit.htm
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Arizona:
Beware of the language of this current form...
This...
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:
https://azdhs.gov/documents/preparedness/epidemiology-disease-control/immunization/school-childcare/personal-belief-exemption.pdf
Formulario de Exención por Creencias Religiosas.pef
http://azdhs.gov/documents/preparedness/epidemiology-disease-control/immunization/school-childcare/religious-belief-exemption-espanol.pdf
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Older NON-incrimating Forms:
From the older VacLib archived pages:
https://web.archive.org/web/20090211000957/http://vaccinetruth.net/exempt/arizona.htm
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)
(.pdf) http://www.azdhs.gov/als/forms/ccgh10.pdf
Schools:
Request for Exemption to Immunization Schools (English and Spanish)
(.pdf) http://azdhs.gov/phs/immun/pdf/school-exemption-form.pdf
Request for Exemption to Immunization - School (Spanish)
Sequoia Choice - AZ Distance Learning - Mesa, AZ. 85211-1405
(.pdf) http://scazdl.org/new/forms/waiver.pdf
ExemptionVacLib-Arizona.doc
(.doc) VaccineTruth.net/letters/ExemptionVacLib-Arizona.doc
If all else fails, and a parent is forced to sign an incriminating form, then write or sign name "Under Duress".
https://consciousawarenessforall.wordpress.com/2015/02/12/duress/
https://www.linkedin.com/pulse/how-sign-your-name-without-assuming-liability-cathy-bilsky
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