COLORADO - IMMUNIZATION EXEMPTIONS by State (includes current statutes, letters & forms)IMMUNIZATION EXEMPTIONS by State (includes current statutes, letters & forms)Colorado Current Statutes & Laws: http://www.nvic.org/Vaccine-Laws/state-vaccine-requirements/colorado.aspx Medical, Religious & Philosophical Exemption is obtained by "submitting to the student's school a statement of exemption signed by one parent or guardian or the emancipated student or student eighteen years of age or older that the parent, guardian, or student is an adherent to a religious belief whose teachings are opposed to immunizations or that they have a personal belief that is opposed to immunizations."
Fight SpamBots! Exemption Letters & Forms... Birth Exemptions: For those who are planning a hospital birth but want to evade invasive routine post natal procedures such as a Hep B shot, vitamin K injection, newborn screening, or the application of silver nitrate in the newborn's eyes, a very specific birthing plan must be submitted to the hospital in advance of the birth. Hospital staff must be informed, in advance, of your needs, wants and desires where your baby and birthing experience are concerned. The same applies to midwives. Religious Exemption from newborn screening allowed. Colo. Rev. Stat. § 25-4-1005 http://www.ncsl.org/programs/health/screeningprivacy.htm Vitamin K Injection... The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert.  (.pdf) http://vaclib.org/chapter/inserts.htm#vitK"WARNING - INTRAVENOUS USE Severe reactions, including fatalities, have occurred during and immediately after the parenteral administration of AquaMEPHYTON® (Phytonadione)."Alternatives to Vitamin K Prophylaxis... Although oral vitamin K is not licensed for use as a drug, drops for oral administration are available. Typically, one drop contains 2 mg. of vitamin K. Contact a midwife in your area, or a birthing supply company (such as birthwithlove.com), or Scientific Botanicals (206 527-5521) where your health care provider can order liquid vitamin K directly. Here's another much safer alternative that your chiropractor or naturopath can order for you. http://www.bioticsresearch.com/Products/BioK.htm A good organic whole food diet along with lots of leafy green vegetables is all that is necessary to prevent vitamin K deficiency in newborns. Sample Vaccine Letters Most states now require the Hepatitis B vaccine for newborns. Many parents are also cornered by emergency room personnel during accident visits. Hospitals nationally are under pressure to utilize every opportunity to score a "hit." If your pediatrician understands your views, get him involved with the hospital. As a last resort, protect your right to receive quality care in the following manner. (Usually, you'll never find anybody in the hospital to sign this simple form): "I certify that the (Name of Vaccine)________ vaccine being administered to (Name of Child)_________ is free from all known and yet unknown zoonotic or human viruses or viral fragments and will not cause acute or chronic illness in the recipient due to viral contamination or as a reaction to the components of this vaccine. (Signature of Physician and Date)_________." If you do get a signature, hold on to the form. (Links to model birth plan letter and acceptance of responsibility) Acceptance of Responsibility. http://www.vaclib.org/legal/accept1.htm Model Birth Plan Letter for Hospital Births. You can attach an exemption from immunizations. In some states, there are religious exemptions from newborn screening tests such as PKU, etc...  (.doc) Model Letter for Hospital Births (Model11425.doc) Model Birth Plan Letter for Hospital Births. This one is more detailed. You can attach an exemption from immunizations. In some states, there are religious exemptions from newborn screening tests such as PKU, etc... (.doc)
Model letter for hospital births 2.doc (11426)
Model Birth Plan Letter for Hospital Births for an adopted child... Model letter for hospital births for adoptions -- Dear Doctor and Medical Staff.doc (11427) (.doc) VaccineTruth.net/letters/Model letter for hospital births for adoptions.doc
The above documents can also be made available in WordPerfect
Hepatitis B Vaccine Refusal from Dr. Sherri Tenpenny's webpage: AFFIDAVIT I/We, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being(s), state Citizen(s) of the Colorado Republic affirm: Be it known to all courts, governments, and other parties that: Being (a person/people) of Strong Christian Morals, it is against (my/our) Deep, Sincerely Held, Religious Convictions to accept the injection of any foreign substance into (my Body/our Bodies) or the Body of (my/our) Child. This includes, but is not limited to, any and all, Vaccinations, Shots, Tests for Diseases, Oral Vaccines, Epidermal Patches and in any other way that Live or Killed Bacterium, Viruses, Pathogens, Germs, or any other Microorganisms, may be introduced into or upon (my/our) newborn's body. This written statement to exempt (my/our) newborn from any immunizations, newborn screening, and the Vitamin K shot, because (Iwe) hold genuine and sincere personal religious beliefs which are inconsistent with these medical procedures & experimentation. The practice of vaccination and the injection or application of any foreign substance is contrary to (my/our) conscientiously held religious beliefs and practices, and violates the free exercise of (my/our) religious principles. 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/our) parental authority to condemn such activity in (my/our) child. The acceptance of this vaccine promotes sexual promiscuity and immoral behavior in direct contradiction to the teachings of (my/our) faith. The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert. http://vaclib.org/chapter/inserts.htm#vitK "WARNING - INTRAVENOUS USE Severe reactions, including fatalities, have occurred during and immediately after the parenteral administration of AquaMEPHYTON® (Phytonadione)."A conflict arises because (my/our) religious convictions are predicated on the belief that all life is sacred. God's commandment "Thou Shall Not Kill" applies to the practice of injection of carcinogenic substances that can kill. (We / I) {First and Last name(s)}, as the {(parent (s) / guardian(s)} of ______________________(name of newborn child) are exercising (our/my) rights under the First Amendment of the US Constitution and [insert Colorado immunization/testing exemptions birth statutes here] to receive Religious Exemption from Vaccination, ALL injections, & testing. 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. The Lord Jesus Christ and Our Creator are the only source of protection of (my body/our bodies) and that of (my/our) family that (I/we) can accept. (I/We) affirm that vaccination & injections of any foreign substances and proteins conflict with (my/our) religious beliefs as stated above. Therefore, (I/we) would request that you accommodate (my/our) religious beliefs and practices by exempting (my/our) newborn child from any vaccinations, injections and testing of any kind. Rest assured that (my family and I/our family) do practice a form of immunization that keeps our immune systems strong and is in keeping with Biblical principles. Further Affiant Saith Not The use of notary below is for identification only, and such use does NOT grant any jurisdiction to anyone. Subscribed and sworn, without prejudice, and with all rights reserved, (Print Name Below) _______________________________________________________________, Principal, by Special Appearance, in Propria Persona, proceeding Sui Juris. _______________________________ Signature of Affiant ACKNOWLEDGMENT state of Colorado county of _________________: On this _______ day of ______________, 200___, before me personally appeared __________________________________, to me known to be the person described in and who executed the foregoing instrument and acknowledged that he executed the same as his free act and deed, for the purposes therein set forth. _______________________________________ (Notary Public) My Commission Expires ______________________________, 200___ Above AFFIDAVIT now available in both Microsoft Word  (.doc) and WordPerfect  (.wpd) format.Birth Certificate and Marriage License Opt-Out: Did you know that you can REFUSE to sign the hospital birth certificates and that there is no law that requires you to do so? See: Marriage Licenses, Birth Certificates & #SSNs Postnatal - 2 months (first "well baby" visit): If you do take your new baby to an MD as opposed to a naturopath and/or chiropractor, please be aware and careful of any forms you sign. We're referring to those "Refusal To Vaccinate" forms put out by the American Academy of Pediatrics. Go to this page below and find out why signing this form is very dangerous. We all know about these forms and how they can be used to undermine parental rights... http://www.vaclib.org/legal/donotsign.htm Generic Vaccine Refusal Form from Dr. Sherri Tenpenny's webpage. (.pdf) http://www.nmaseminars.com/files/Vaccine_Refusal_Form.pdfState Form Required: No. The Colorado immunization record/cetificate is usually required or preferred by the schools/colleges. There is a section that can be checked off for desired exemption, on back of form. Here is a copy of just the STATEMENT OF EXEMPTION TO IMMUNIZATION LAW part of the Colorado Certificate of Immunization Form. The exemption is usually on the back of the Certificate of Immunization form. (.doc) VaccineTruth.net/letters/Colorado11507.docColorado Department of Public Health and Environment Immunization/Exemption Forms and Materials (.pdf) CO Revised Statutes: School Entry Immunization (Not an exemption form. Only the current statutes.) Current Colorado Immunization and Exemption Forms. (.pdf) Certificate of Immunization Statement of exemption is on page 2. (Spanish language is included on this form) (.pdf) Certificate of Immunization for Electronic Records
Statement of exemption is on page 2. (Spanish language is included on this form) (.pdf) Certificate of Immunization for College Students Statement of exemption is on page 2. (Spanish language is included on this form) (.pdf) CO Revised Statutes: Meningococcal Information for College Students (.pdf) http://www.cdphe.state.co.us/dc/Immunization/Forms/FORM-blueadminrecordsheet.pdf COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT - CERTIFICATE OF IMMUNIZATION - Exemption Form on back. (Spanish language is included on this form) (.pdf) http://www.cdphe.state.co.us/dc/Immunization/Forms/CARD-certofimm.pdf
Daycare & Preschools: Use above forms. You can also use this religious exemption statement. Colorado Religious Exemption Statement (11508) (.doc)
VaccineTruth.net/letters/Colorado11508.doc A CareGiver Network for Child Care Professionals Aurora, CO 80046-0861 STATEMENT OF EXEMPTION TO IMMUNIZATION LAW on page 2 (.pdf) http://www.caregivernetwork.org/files/Documents/cert_imm.pdfPlanetPlay licensed drop-in child-care center Lonetree, Colorado 80130 STATEMENT OF EXEMPTION TO IMMUNIZATION LAW on page 2 (.pdf) http://www.planetplaykids.com/immunization.pdfSchools: Use above forms or religious exemption statement. Colorado Religious Exemption Statement (11508) (.doc) VaccineTruth.net/letters/Colorado11508.docThe above documents can also be made available in WordPerfect (.wpd) format.Please contact us if you want the letters in WordPerfect.
Here is a great affidavit that can be used for Daycare, Preschools and Schools. AFFIDAVIT I/We, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being(s), state Citizen(s) of the Colorado Republic affirm: Be it known to all courts, governments, and other parties that: Being (a person/people) of Strong Christian Morals, it is against (my/our) Deep, Sincerely Held, Religious Convictions to accept the injection of any foreign substance into (my Body/our Bodies) or the Body of (my/our) (Child/Children). This includes, but is not limited to, any and all, Vaccinations, Shots, Tests for Diseases, Oral Vaccines, Epidermal Patches and in any other way that Live or Killed Bacterium, Viruses, Pathogens, Germs, or any other Microorganisms, may be introduced into or upon my body or any of my children's bodies. This written statement to exempt (my/our) child from any immunizations, TB testing, and other shots/injections, because (I/we) hold genuine and sincere personal religious beliefs which are inconsistent with these medical procedures and experimentation. The practice of vaccination and the injection of any foreign substance is contrary to (my/our) conscientiously held religious beliefs and practices, and violates the free exercise of (my/our) religious principles. The attenuated virus used to produce the Rubella vaccine (RA27/3) was obtained from an aborted fetus and then cultivated on fetal tissue from another aborted baby (WI-38) and is also in the rubella portion of the MMR-II vaccine. The Chickenpox vaccine containing WI-38, MRC-5 and Hepatitis-A vaccine (MRC-5) were obtained from human babies that were electively aborted. A conflict arises because (my/our) 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 these vaccines 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 and therefore usurps (my/our) parental authority to condemn such activity in (my/our) child. The acceptance of this vaccine promotes sexual promiscuity and immoral behavior in direct contradiction to the teachings of (my/our) faith. (We / I) {First and Last name(s)}, as the {(parent (s) / guardian(s)}of _________________________(name of child) are/am exercising (our/my) rights under the First Amendment of the US Constitution and §C.R.S. 25-4-1704 (4) (b) to receive Religious Exemption from Vaccination. 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. The Lord Jesus Christ and Our Creator Yahweh are the only source of protection of my body and that of my family that I can accept. (I/We) affirm that vaccination & injections of any foreign substances and proteins conflict with (my/our) religious beliefs as stated above. Therefore, (I/we) would request that you accommodate (my/our) religious beliefs and practices by exempting (my/our) child from any vaccinations, injections and testing of any kind. Rest assured that (my family and I/our family) do practice a form of immunization that keeps our immune systems strong and is in keeping with Biblical principles. Further Affiant Saith Not The use of notary below is for identification only, and such use does NOT grant any jurisdiction to anyone. Subscribed and sworn, without prejudice, and with all rights reserved, (Print Name Below) _______________________________________________________________, Principal, by Special Appearance, in Propria Persona, proceeding Sui Juris. _______________________________ Signature of Affiant ACKNOWLEDGMENT state of Colorado county of _________________: On this _______ day of ______________, 200___, before me personally appeared __________________________________, to me known to be the person described in and who executed the foregoing instrument and acknowledged that he executed the same as his free act and deed, for the purposes therein set forth. _______________________________________ (Notary Public) My Commission Expires ______________________________, 200___ Here is a copy of just the STATEMENT OF EXEMPTION TO IMMUNIZATION LAW part of the Colorado Certificate of Immunization Form. The exemption is usually on the back of the Certificate of Immunization form. (.doc) VaccineTruth.net/letters/Colorado11507.doc
(.pdf)
Colorado Certificate of immunization record back page (EXEMPTION) Spiral Academy 4935 Sprangler Drive · Colorado Springs Colorado · 80922 CERTIFICATE OF IMMUNIZATION/EXEMPTION EXEMPTION STATEMENT (Medical, Religious, and Personal) page 2 (.pdf) http://www.spiralacademy.org/images/Imumunization%20Cert.pdfColorado Academy of Independent Learners COLORADO LAW REQUIRES THIS FORM BE COMPLETED AND PROVIDED TO THE SCHOOL STATEMENT OF EXEMPTION TO IMMUNIZATION LAW on page 2. (DECLARACIÓN RESPECTO A LAS EXENCIONES DE LA LEY DE VACUNACIÓN) (.pdf) http://cail.home.mindspring.com/CARD-certofimm.pdfSteamboat Springs Christian Heritage School Steamboat Springs, CO 80487 STATEMENT OF EXEMPTION TO IMMUNIZATION LAW at bottom of page. (.pdf) http://www.chscol.com/pdf/ImmunizationForm.pdfSummer Camps: Red Cloud (.pdf) http://www.campredcloud.org/pdf/oehealthform.pdfYMCA of the Pikes Peak Region Camper Information Form Exemption on page 4 (.pdf) http://www.ppymca.org/files/DCCamperForms.pdfBuckhorn Camp STATEMENT OF EXEMPTION TO IMMUNIZATION LAW Page 8 (.pdf) http://www.buckhorncamp.org/assets/common/2006-YouthCampsRegistrationPacket.pdfRenaissance Adventures Health Form 2005 STATEMENT OF EXEMPTION TO IMMUNIZATION LAW on pages 3 and 4. (.pdf)
http://renaissanceadventures.com/files/Health.pdfAdventures Experiences, Inc. Base Camp of the Rockies Christian Wilderness Retreat Center and Christian Wilderness Adventure Programs STATEMENT OF EXEMPTION TO IMMUNIZATION LAW on page 2. (.pdf)
http://www.aeibasecamp.com/forms/coloradoimmunizationcertificate.pdfColorado Twin Peaks Bible Camp CAMPER REGISTRATION Exemption is checked off at the bottom of the page. Scanned copy. (.pdf)
http://www.twinpeaksbiblecamp.org/pdfiles/Immunization.pdf YMCA Camp Shady Brook Health History and Examination Form STATEMENT OF EXEMPTION TO IMMUNIZATION LAW on page 7. (.pdf)
http://shadybrook.ppymca.org/files/CamperForms.pdfDinosaur Ridge | Morrison, Colorado STATEMENT OF EXEMPTION TO IMMUNIZATION LAW on page 6. (.doc) http://www.dinoridge.org/Summer%20Camp%20Registration%20Forms%202004.docCROW CANYON ARCHAEOLOGICAL CENTER HIGH SCHOOL ARCHAEOLOGY PROGRAM SCHOLARSHIP APPLICATION FORM Student Day Program STATEMENT OF EXEMPTION TO IMMUNIZATION LAW bottom of page 19. (.pdf)
http://www.crowcanyon.org/programs/packets/day_program_parent_student_web.pdfMultiday Programs STATEMENT OF EXEMPTION TO IMMUNIZATION LAW bottom of page 19. (.pdf)
http://www.crowcanyon.org/programs/packets/multiday_parent_student_web.pdfSome older Colorado Forms... (.pdf) 2001 Form (.pdf) 1997 FormOpt-Outs: Military Recruiters: STUDENT OPT OUT FORM regarding the RELEASE OF NAME, ADDRESS, AND TELEPHONE NUMBER TO MILITARY RECRUITERS (.pdf) http://www.militaryfreeschools.org/PDF/optout2.pdfUNDERGROUND ACTION ALLIANCE STUDENT OPT OUT FORM (.pdf) http://www.militaryfreezone.org/opt_out.pdf (.doc) http://veterans4peace.org/opt_out.docSAMPLE ENGLISH - BINGUAL FORMS FOR OPTING OUT Act to Protect Your Privacy from Military Recruiters (.pdf) http://www.afsc.org/pacificsw/documents/Opt-Out-Form.pdf STUDENT OPT-OUT - Google Search STUDENT OPT-OUT NOTICE regarding the instruction of sexuality to children: STUDENT OPT-OUT NOTICE Valid in all 50 states (.pdf) http://www.ccv.org/images/StudentOptOutNotice.PDF (.pdf) http://www.catholiccitizens.org/content/img/f26422/opt%20out%20notice.pdf (.html) http://www.ccv.org/images/StudentOptOutNotice.htm
Entire packet... (.doc) http://www.mfc.org/respect/Website/Links%20on%20Web%20Page/Opt-Out%20Packet.docSTUDENT OPT-OUT NOTICE - Google Search Colleges and Universities: (.pdf) Certificate of Immunization for College Students Statement of exemption is on page 2. (Spanish language is included on this form) (.pdf) CO Revised Statutes: Meningococcal Information for College Students Colorado State University COLORADO LAW REQUIRES THIS FORM BE COMPLETED AND PROVIDED TO THE SCHOOL Colorado Alternative Certificate of Immunization for College Students Approved 2-2003 by Colorado State University Statement of Exemption to Immunization Law at bpttpm of page. (.pdf) http://www.colostate.edu/Depts/HHS/pdf/codptcer.pdf
Rocky Mountain College of Art + Design CERTIFICATE OF IMMUNIZATION FOR COLLEGE STUDENTS Approved 11/2003 by CDPHE Colorado law requires that form be completed and provided to the school. Check off Statement of Exemption to Immunization Includes meningococcal vaccination information and option for refusal on page 2. (.pdf) http://www.rmcad.edu/admissions/pdf/student_immunization.pdf
University of Colorado at Boulder COLORADO LAW REQUIRES THIS FORM BE COMPLETED AND PROVIDED TO THE SCHOOL Check off Statement of Exemption to Immunization Includes meningococcal vaccination information and option for refusal on page 2. (.pdf) http://www.colorado.edu/healthcenter/downloads/imm_record.pdf University of Denver Immu Form and statement of exemption (.pdf) http://www.du.edu/duhealth/pdfs/immunizationForm.pdf CERTIFICATE OF IMMUNIZATION FOR COLLEGE STUDENTS CDPHE Imm 11/03 (Statement of Exemption at bottom of form) University of Northern Colorado (.pdf)
http://www.unco.edu/shc/PDF/FORM-collegeCI.pdfIMMUNIZATION FOR COLLEGE STUDENTS CDPHE Imm 11/03 (Statement of Exemption at bottom of form) Western State College of Colorado (.pdf) http://www.western.edu/studaff/pdf/MMR2004.pdf
These Google searches are mostly the college and school exemptions. There are always new forms coming online. Keep a regular check on these to look for newly added forms. Some are for daycare too. The links are the actual keywords that are used.
COLORADO OFFICIAL OSHA HEPATITIS B VACCINE DECLINATION FORM TB Testing Alternatives... TB can be detected by biofeedback machines that are hooked up to a computer, such as the QXCI, Best BioMeridian MSAS (Meridian Stress Assessment) or Electro Dermal Screening, Quantum Life System, and the F-Scan. You will need to ask specifically for a pathogen scan, especially TB. You will also need to request a printout with the results. Here are some of the practitioners for Colorado Colorado BEST™ BioMeridian Practitioners: Center For Intergrative Health 9285 Teddy Lane, Suite 135 Lone Tree, CO 80124 (303) 858-8868 Fax: (303)858-8878 http://www.c4ih.com MSA-21™ Single channel stress testing system developed by BioMeridian™ Please call contact below to find additional BioMeridian practitioners in your area or closeby. Oksana Gorodetsky Marketing/Administrative Coordinator BioMeridian International 12411 South 265 West, Suite F Draper, UT 84020 T 801-501-7517 F 801-501-7518 Toll Free 888-224-2337 ogorodetsky@biomeridian.com Colorado QXCI Practitioners: Main page of practitioners: http://www.theqxci.com/information.php For information on purchase or lease of the new Quantum Life BioFeedback L.I.F.E. System, please email Donna at Exemptions Contact Page and leave your name, mailing address, phone number and email. If you're inquiring for another interested individual or practitioner, please leave their information. The company will then send information and contact the interested parties. Or you may call 1-888-249-1421. Information on this page is provided and sponsored by: http://www.vaccinetruth.net/cbswork/cbswork.htm! CbsworkOrderForms2007  (.pdf)
CbsworkOrderForm2007.pdf (.doc)
CbsworkOrderForm2007.doc (.wpd)
CbsworkOrderForm2007.wpd (.rtf)
CbsworkOrderForm2007.rtf |
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