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Vaccination Liberation Information
Connecticut State Exemption Page
VacLib.org & VaccineTruth.net Exemption Page

Click for the desired information for your state

New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: Schools  |   DayCare  |   Preschool  |   K-12  |   College  |   (options) OptOutRegistry  |  
Adult Issues: Employment  |   TB_and/or_LeadTesting
Statutes/Laws  |   Waivers_CareInSigning  |   Misc_Info, Sponsors, etc.

Statutes/Laws
Link to state law.
National Vaccine Information Center:
Link to state law.


For additional help with exemptions, birth plan,etc questions:
Non_Vaccinating_Physicians

Check our Vaccination Liberation State Chapter and other resource organizations page for help in your state.

If your state specific help is not available, Contact us.


Available Exemptions
Medical  &  Religious

"A statement from the parents of such child that such immunizations would be contrary to the religious beliefs of such child."

PDF documents (.pdf)

A PDF reader is required for PDF Files:
Free Foxit Reader 12 MB file size.

Or Free Download of Acrobat Reader: [Adobe. 43 MB file size]


Click for the desired information for your state

New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: Schools  |   DayCare  |   Preschool  |   K-12  |   College  |   (options) OptOutRegistry  |  
Adult Issues: Employment  |   TB_and/or_LeadTesting
Statutes/Laws  |   Waivers_CareInSigning  |   Misc_Info, Sponsors, etc.

NewBorn Birthing Plan and Birth Exemptions
BirthExemptions  |   Birthing_Plans  |   Vitamin_K  |   Hepatitis_B  |   Eyedrops  |   Newborn_Screening

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.

http://www.cga.ct.gov/2012/sup/chap368a.htm

Sec. 19a-55. (Formerly Sec. 19a-21b). Newborn infant health screening. Tests required. Fees. Exemptions. Regulations.
(c) The provisions of this section shall not apply to any infant whose parents object to the test or treatment as being in conflict with their religious tenets and practice. The commissioner shall adopt regulations, in accordance with the provisions of chapter 54, to implement the provisions of this section.

Sec. 19a-87b. (Formerly Sec. 17-585(b)-(d)). License required for family day care homes. ...
(f) ... [excerpt] Such regulations shall provide appropriate exemptions for children for whom such immunization is medically contraindicated and for children whose parents object to such immunization on religious grounds.


http://www.ct.gov/dph/cwp/view.asp?a=3122&q=387750

SEC. 19-13-D42. Objection of parents to test
If the parents of an infant object in writing to a test for phenylketonuria and other inborn errors of metabolism, as being in conflict with their religious tenets and practice, such fact shall be reported to the state department of health and a statement on a form provided by the state department of health signed by the parents shall be made a part of the infant's hospital record.

Hearing Screening...

CONNECTICUT

Statute: Sec. 9. The provisions of this subsection shall not apply to any infant whose parents object to hearing screening as being in conflict with their religious tenets and practice.

[Source: HB 8007, 1997]

(b) A parent who refuses to allow his or her infant to be screened for a hearing impairment based upon religious tenets and practice shall sign a statement attesting to said refusal which shall include a statement by a licensed health care provider that the parent was informed of the medical consequences of such refusal. The document shall identify the specific reasons for the refusal and shall be placed in the infant's medical record. If a parent declines to sign the refusal statement, the institution shall document in the infant's medical record the reason for the refusal by the parent to permit newborn hearing screening and a statement that the parent refused to sign the document and was informed of the medical consequences of such refusal.

[Source: Rules (June 18 Special Session, PUBLIC ACT NO. 97-8)]

(.doc) http://www.dph.state.ct.us/phc/docs/82_Newborn_Hearing_Screenin.doc

Steps:
  • Create the Birthplan. Or modify one of our ours to fit your state laws and any other personal circumstances. (see below)

  • Sign the birthplan in front of a Notary.

  • Submit the birth plan to your hospital or midwife. Keep a couple extra copies in case plans change.

  • Make sure affected parties (doctors, nurses, etc) understand your requirements and wishes.
  • .
  • Plan on having one or two trusted persons stay with the mother and child to watch the child at all times while in the hospital, so no unwanted injections are given the baby.

  • The birth plan arrangements and letter should be turned in before delivery date.

  • The "Refusal to Permit Medical Treatment" form below is optional.

Birth Plans (To be used with hospitals and/or midwives)
(Links to model birth plan letters)

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...

Information on the Dangers of Hospital Birth and the Benefits of Home Birth from gentlebirth.org

Our best and most itemized birthplan:
Word-Document (.doc) birthplan-itemized.doc  |   PDF-Document (.pdf) birthplan-itemized.pdf

(HTML) BirthPlan-Itemized for reading on screen. Includes handy small dictionary of terms in the document.

Word-Document (.doc) Model Letter for Hospital Births (Model11425.doc)

Model Birth Plan Letter for Hospital Births. This one is more detailed.

Word-Document (.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)
Word-Document (.doc) Model letter for hospital births for adoptions.doc


The birth plan arrangements and letter should be turned in before delivery date.
This "Refusal to Permit Medical Treatment" form below is optional.

"Refusal to Permit Medical Treatment" form
A generic form.
PDF-file (.pdf) letters/refusal_treatment.pdf

It would be good idea to use the AFFIDAVIT below AND a model birth plan letter from above above.
Affidavit - Birth Exemptions
HTML (simple text) Affidavit to modify.

AFFIDAVIT in Microsoft Word Word-Document (.doc) format. (may be modified)

The following paragraph may be inserted, with the appropriate modifications, into either of the Affidavits above:

(We / I) {First and Last name(s)}, as the {(parent (s) /guardian(s)} of (name of newborn child) are exercising our rights under the First Amendment of the US Constitution , Conn. Gen. Stat. § 19a-55 (b), Statute: Sec. 9, and under Conn. Gen. Stat. § 19a-79(a)(1) to receive Religious Exemption from Vaccination, ALL injections, & testing.

If your Title and Paragraph number of your state law is not pasted above, click here for the link to your state law.

Vitamin K Injection...

The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert.
http://fdb.rxlist.com/drugs/drug-9003-Aqua-Mephyton+Inj.aspx?drugid=9003&drugname=Aqua-Mephyton+Inj
"The injectable form of vitamin K can rarely cause severe (sometimes fatal) allergic reactions when given by injection into a muscle or vein. Therefore, vitamin K should be injected into a muscle or vein only when it cannot be given by injection under the skin or taken by mouth, or when your doctor has judged that the benefit is greater than the risk. Seek immediate medical attention if you experience symptoms of an allergic reaction such as rash, itching, swelling, dizziness, or trouble breathing."
Potential exists for the newborn to experience hypersensitivity to any component of this medication.
Each milliliter contains: Phytonadione ............. 2 mg or 10 mg
Inactive ingredients:
Polyoxyethylated fatty acid derivative ................... 70 mg
Dextrose...................................................................... 37.5 mg
Water for Injection, q.s. .................................................. 1 mL
Added as preservative: Benzyl alcohol ...................... 0.9%

Links to prescribing information for Vitamin K:
http://vaclib.org/chapter/inserts.htm#vitK

Archive: Year 2002 Merck Vitamin K Package Insert - Aquamephyton PI | posted on Scribd

Alternatives to Vitamin K Prophylaxis...

Although oral vitamin K is not licensed for use as a drug by the FDA, 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. Or order directly from Amazon.com

Biotics Research, Bio-K Mulsion - 1 fl oz

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.


Hepatitis B Vaccine
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 by asking hospital personal to sign the following waiver. Usually, you'll never find anybody in the hospital to sign this simple form, but you well get relief from demands to vaccinate your child.

"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.

See Birth Plans for more information on avoiding Hep B Vaccination at birth

Eyedrops
Some states require Prophylaxis against Gonococcal OPHTHALMIA NEONATORUM.

A discussion of medical and legal issues regarding Silver Nitrate in the eyes of the newborn is here:
PDF file: Statutory Law USA: Requiring Silver Nitrate in Eyes of Newborns at: http://www.rbs2.com/SilvNitr.pdf
Written by Dr. Ronald B. Standler, attorney in Massachusetts and consultant

Blog type discussion of pros and cons of eyedrops for newborn is here: http://answers.google.com/answers/threadview/id/20050.html


New Born Screening
U.S. states now require screening of newborn babies for specific diseases.

Conditions and legal status of "requirement" of newborn to be screened for each state:
National Newborn Screening Status Report - http://genes-r-us.uthscsa.edu/sites/genes-r-us/files/nbsdisorders.pdf

Newborn Genetic Screening Privacy Laws
(includes links to laws for various states)
Archived Copy: http://web.archive.org/web/20130603035608/http://www.ncsl.org/issues-research/health/newborn-genetic-and-metabolic-screening-laws.aspx

Newborn screening From Wikipedia, the free encyclopedia
http://en.wikipedia.org/wiki/Newborn_screening

Federal NewBorn Screening Law (from Families of Spinal Muscular Atrophy)
http://www.fsma.org

Click for the desired information for your state

New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: Schools  |   DayCare  |   Preschool  |   K-12  |   College  |   (options) OptOutRegistry  |  
Adult Issues: Employment  |   TB_and/or_LeadTesting
Statutes/Laws  |   Waivers_CareInSigning  |   Misc_Info, Sponsors, etc.

Waivers - Take Care In Signing
If you take your new baby to an MD as opposed to a naturopath and/or chiropractor, please be aware of and careful of any forms you sign.

Our WARNING below is about signing (some) state approved and AAP created forms. See this letter from our director, Ingri Cassel, before you consider signing waiver forms.

WARNING!

Dear VacLib Members and Friends -

Wanted to give you all a heads up on state issued exemption forms. I haven't had to deal with this personally for several years, and I always crossed out sentences or clauses, and often adding some of my own, before signing their exemption of medical release type of forms. When Donna Carrillo began to diligently search out existing exemption forms and posting them, I read over a couple of them and encouraged people to make up their own whenever possible. After having a "closer encounter" with such a form - a form provided to the state of Idaho by the American Academy of Pediatrics and the Centers for Disease Control and Prevention and used by licensed Idaho daycares, I was shocked into the VERY REAL danger of signing these forms without changing them significantly.

Any form one affixes their initials to, dates and affixes their signature to at the end is a LEGAL document. All statements prior to your signature you must agree to fully OR restrict your signature to say that you are signing under TDC - threat, duress, and coercion. The form that my daughter was told she needed to fill out for this daycare is posted here: ChildCareExemptForm.pdf. On this form, she crossed out all the "nots" and in her personal statement she further clarified that she understands fully the risks of vaccinating her child.

I have since found out that most public schools and daycares in other states also use a similar form. Basically, by initialing and signing this form as is, you are admitting to understanding that "vaccine preventable" diseases are extremely deadly and ALSO admitting to negligence for willfully denying your son/daughter the life saving protection that vaccines offer. These forms are MEANT to not only be intimidating but to catch the legally ignorant off guard. This is very serious to me since all states have adopted the federally funded Child Abuse Prevention and Treatment Act which gives states the right to literally steal your children for up to 48 hours -- the time they have to prove child neglect OR abuse.

If it were ME, I would insist that they accept a form that I provide them since it satisfies the law. If there are any problems or they insist on me using their form, I would cite the law and ask the school or daycare provider where it actually says in state statute that this particular form is the only form that will satisfy the law. Since your parental rights are at stake here, it is best to be vigilant and err on the side of being overly cautious.


A modified AAP form is posted here that you may wish to use with your doctor: AAPmodified.htm

AAPmodified.doc MSWord .DOC file  |   AAPmodified.pdf PDF file, best for printing.

Not all State employees are aware of the law and many exhibit the Hitler Complex. Take a firm stand. Some individuals have had difficulty getting the required forms. Such arrogance on the part of State employees should be reported to the Director of your state Department of Health.

See:   AnaiRhoads.org Why Signing a Waiver to Avoid Vaccines Can Be Considered Abuse
She is referring to the Refusal To Vaccinate Form developed by The American Academy of Pediatrics, not a regular religious or conscientious exemption letter or form.


Click for the desired information for your state

New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: Schools  |   DayCare  |   Preschool  |   K-12  |   College  |   (options) OptOutRegistry  |  
Adult Issues: Employment  |   TB_and/or_LeadTesting
Statutes/Laws  |   Waivers_CareInSigning  |   Misc_Info, Sponsors, etc.

Letters Forms Affidavits
Links to Model birth plan letters (above).

Link to Refusal to Permit Medical Treatment form

Links to Affidavit - Birth

An Adult Affidavit, with Christian beliefs, is here. (MSDOC file) Feel free to modify as needed.


Dr. Tenpenny has the following forms on her web site. The forms are generic and may be used in any state.

Affidavit for Parents Participating in International Adoption (Word) (pdf)
Hep B vaccine in hospital for newborn refusal, sample (pdf)
OSHA Declination Statement Form (also, pdf)
Religious exemption letter that was approved in Florida (Word) (pdf)
School Vaccine Exemption Form, sample (Word) (pdf)
TB testing refusal, sample (pdf)
Childcare and School Immunization Requirements

http://drtenpenny.com/forms/

Sample Vaccine Letters. from www.vaccines.bizland.com/letters.htm archived on VacLib.org/letters/doctor.htm

Short Sample Vaccine Letter

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.

The ACCEPTANCE OF RESPONSIBILITY is imperative in exercising your rights for legal exemptions from forced medical experimentation and legalized bioterrorism. DO be prepared to fight for your baby's rights!
An index page to various Acceptance of Responsibility) forms is here:
. http://www.vaclib.org/legal/accept.htm

Religious exemption forms will be listed below under Daycare Schools Colleges

Did not find your state exemption form on our site?
Then try this link to forms for all 50 states and D. of Columbia.
http://experimentalvaccines.org/vaccine-exemption-forms/


Click for the desired information for your state

New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: Schools  |   DayCare  |   Preschool  |   K-12  |   College  |   (options) OptOutRegistry  |  
Adult Issues: Employment  |   TB_and/or_LeadTesting
Statutes/Laws  |   Waivers_CareInSigning  |   Misc_Info, Sponsors, etc.

DayCare - Preschool - Schools - Colleges
DayCare-Preschool-K-12-Colleges
DayCare  |   Preschool  |   K thru 12  |   Colleges

DayCare
Same forms as school below. A state form is not required:

Preschool
Same forms as school below. A state form is not required:

Kindergarten & Schools
Religious Exemption Form
(.pdf) http://www.sde.ct.gov/sde/lib/sde/PDF/deps/student/health/Religious_Exemption.pdf

Medical Exemption Form
(.pdf) http://www.sde.ct.gov/sde/lib/sde/PDF/deps/student/health/Medical_Exemption.pdf

Links to both Medical and Religious Exemption Certification Forms
English, Spanish, Polish, Brazilian Portuguese, Haitian Creole, and Traditional Chinese:
http://www.ct.gov/dph/cwp/view.asp?a=3136&q=388416

CT Vaccine Exemption Forms
Central Connecticut Chiropractic
Compliments of Dr. Luigi DiRubba
391 Highland Avenue, Suite 1
Cheshire, CT 06410
Religious Exemption
(.pdf) http://images.vortala.com/chiropractor/USA/Connecticut/Cheshire/usCentralConnecticutChiropractic/SiteGraphics/Religious_Exemption.pdf
Medical Exemption
(.pdf) http://images.vortala.com/chiropractor/USA/Connecticut/Cheshire/usCentralConnecticutChiropractic/SiteGraphics/immunization-exemption.pdf


Colleges/Universities
University of Connecticut Student Health Services Storrs, CT 06269
Exemption to Immunization Requirements
(.pdf) Immunization Exemption Form - University of Connecticut

University of Connecticut School of Law
(.pdf) Immunization Exemption Personal Conviction
Office of the Registrar
55 Elizabeth Street
Hartford, Connecticut 06105

UNIVERSITY OF CONNECTICUT HEALTH CENTER
DIVISION OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE
EMPLOYEE HEALTH SERVICE
For Measles, Rubella, MMR, Td, Influenza Vaccine
(.pdf) Old/Archived:
IMMUNIZATION CONSENT / DECLINATION FORM
(This form also applies to University Employees and Volunteers)

Connecticut College
Religious Exemption Form
(.pdf) http://www.conncoll.edu/media/website-media/campuslife/SHSReligiousExemption.pdf


Central Connecticut State University (CCSU)
REQUEST FOR EXEMPTION from MEASLES, RUBELLA OR MENOMUNE/MENACTRA, HEPATITIS B** VACCINATION REQUIREMENT
http://www.ccsu.edu/uploaded/departments/AdministrativeDepartments/Health_Services/Exemption_from_Immunization_form_2010.pdf (.pdf) http://www.ccsu.edu/uploaded/departments/AdministrativeDepartments/Health_Services/Exemption_from_Immunization_form_2010.pdf
Will need additional religious statement...
"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.

AFFIDAVIT for Connecticut Adult (college religious exemption) ... Edit as needed... See link below.

An Adult Affidavit, with Christian beliefs, is here. (MSDOC file) Feel free to modify as needed.

Click for the desired information for your state

New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: Schools  |   DayCare  |   Preschool  |   K-12  |   College  |   (options) OptOutRegistry  |  
Adult Issues: Employment  |   TB_and/or_LeadTesting
Statutes/Laws  |   Waivers_CareInSigning  |   Misc_Info, Sponsors, etc.

OptOutRegistry for Vaccines
and various other Opt-Outs
Vaccine Registry Opt-Outs:

KNOW YOUR RIGHTS
Confidentiality of Your Child’s Vaccination Records
FERPA: The Family Educational Rights and Privacy Act
http://www.vaxchoicevt.com

     - - - - Other Opt-Outs - - - -:

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

Military Recruiters:

STUDENT OPT OUT FORM regarding the
RELEASE OF NAME, ADDRESS, AND TELEPHONE NUMBER TO MILITARY RECRUITERS
(.pdf) Archived letter from www.militaryfreeschools.org

UNDERGROUND ACTION ALLIANCE STUDENT OPT OUT FORM
Word-Document (.doc) Archived on VacLib.org: http://veterans4peace.org/opt_out.doc

SAMPLE ENGLISH - BILINGUAL FORMS FOR OPTING OUT
Act to Protect Your Privacy from Military Recruiters
Information links and forms at AFSC site

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-file (.pdf) http://www.catholiccitizens.org/content/img/f26422/opt%20out%20notice.pdf

STUDENT OPT-OUT NOTICE - Google Search


Click for the desired information for your state

New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: Schools  |   DayCare  |   Preschool  |   K-12  |   College  |   (options) OptOutRegistry  |  
Adult Issues: Employment  |   TB_and/or_LeadTesting
Statutes/Laws  |   Waivers_CareInSigning  |   Misc_Info, Sponsors, etc.

Employment
OSHA
Standard Interpretations
09/23/1997 - The Bloodborne Pathogen Standard and the Enforcement Procedures for TB.
"Finally, be aware that participation in the employer's skin testing program is voluntary on the part of the employee. OSHA does not require that employees participate in TB skin testing, only that the employer make such skin testing available to employees."
See TB Testing for more information.

US Fish and Wildlife Service Form 3-2283
Hepatitis B Immunization Consent/Refusal Form
PDF-file (.pdf) http://www.fws.gov/forms/3-2283.pdf

Click here for an Affidavit for Adult (college & employment religious exemption) ... Edit as needed...

You may use the AFFIDAVIT for Adult above & edit as needed...
You would still use the OSHA Hepatitis B declination form for Hepatitis B vaccine.

UNIVERSITY OF CONNECTICUT HEALTH CENTER
DIVISION OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE
EMPLOYEE HEALTH SERVICE
For Measles, Rubella, MMR, Td, Influenza Vaccine
(.pdf) IMMUNIZATION CONSENT / DECLINATION FORM
(This form also applies to students, residents & volunteers)

Click for the desired information for your state

New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: Schools  |   DayCare  |   Preschool  |   K-12  |   College  |   (options) OptOutRegistry  |  
Adult Issues: Employment  |   TB_and/or_LeadTesting
Statutes/Laws  |   Waivers_CareInSigning  |   Misc_Info, Sponsors, etc.

TB and/or Lead Testing

TB Test:

Tuberculosis (TB) testing: Students new or returning to Darien Public Schools who were either born or have lived outside United States are to have a PPD Mantoux Tuberculin Test within one year before entry. If positive with induration 15mm or greater, student must document a negative chest x-ray within one year before entry. All immunizations must document month, day, and year. Blood titers must indicate date and result. Per state law, We cannot allow 6th , 7th, 8th, and 10th graders or new students to start school until this is on file with the school nurse.

Pamela E. Peters APRN Director of Darien School Health Services
Telephone: 203-655-3981x1127
Email: ppeters@darien.k12.ct.us

Connecticut College - TB SKIN TEST (PPD/Mantoux) WITHIN THE PAST YEAR IS REQUIRED of ALL STUDENTS. CHEST X-RAY IS NECESSARY IF POSITIVE TB (PPD) TEST. HAVING BCG VACCINE DOES NOT EXEMPT TESTING FOR ADMISSION.

University of Connecticut - Tuberculosis (TB) Risk Questionnaire (required if transferring to Storrs from a Regional Campus)

Eastern Connecticut State University - Mantoux/PPD Tuberculosis Skin Testing Required

UNIVERSITY OF CONNECTICUT HEALTH CENTER
DIVISION OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE
(MUST HAVE 2 TUBERCULIN SKIN TESTS 2 WEEKS APART WITHIN PAST 12 MONTHS) TB-Links/Exemptions

Generic letter for Exemption to TB Testing:
HTML (text): Exemption-tb-test.html

MS Doc file: Exemption-tb-test.doc

OSHA
Standard Interpretations
09/23/1997 - The Bloodborne Pathogen Standard and the Enforcement Procedures for TB.
"Finally, be aware that participation in the employer's skin testing program is voluntary on the part of the employee. OSHA does not require that employees participate in TB skin testing, only that the employer make such skin testing available to employees."
TB and Lead Testing Links:
F L Y E R    LETTER    Exemption_Letters    OSHA_and_TB_test    Tubersol    Treatment    TB_Screening    Alternatives/QuantiFERON_TB_Gold_testimony

The above TB and Lead exemption letters are courtesy of Deirdre DeVane of Wash DC. Thank you Deirdre!
The adult TB letters were edited by Sherri Tenpenny. Thank you Sherri!

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 Connecticut

Connecticut BEST™ BioMeridian Practitioners:

Joy Pacitto, MS, CCN
1880 Silas Deane Hwy., Rocky Hill, CT 06067
(860) 529-8313
Joy Pacitto is a certified clinical nutritionist. She designs customized nutritional programs for the individual, not the condition/illness. Assessment techniques include muscle testing (CRA), meridian balancing (EAU) using the B.E.S.T. System, and metabolic analysis. All clients receive a complete food evaluation, a compatible diet and a personalized vitamin and mineral evaluation. Joy also uses homeo-pathy and herbal remedies for balancing.

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

Connecticut 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 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 1-407-672-6144.


Click for the desired information for your state

New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: Schools  |   DayCare  |   Preschool  |   K-12  |   College  |   (options) OptOutRegistry  |  
Adult Issues: Employment  |   TB_and/or_LeadTesting
Statutes/Laws  |   Waivers_CareInSigning  |   Misc_Info, Sponsors, etc.

Misc Info - Sponsors - Etc.
See TB-Links above.