CONNECTICUT - IMMUNIZATION EXEMPTIONS by State (includes current statutes, letters & forms)IMMUNIZATION EXEMPTIONS by State (includes current statutes, letters & forms)Connecticut Current Statutes & Laws: http://www.nvic.org/Vaccine-Laws/state-vaccine-requirements/connecticut.aspx Medical & Religious "A statement from the parents of such child that such immunizations would be contrary to the religious beliefs of such child."
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. http://www.ncsl.org/programs/health/screeningprivacy.htm Religious Exemption from newborn screening allowed. Conn. Gen. Stat. § 19a-55 (b) Sec. 19a-55. (Formerly Sec. 19a-21b). Newborn infant health screening. Tests required. Exemptions (b) 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. http://www.dph.state.ct.us/BCH/NBS/Statutes/Statutes.htm 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.docVitamin 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 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. 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 From this website... http://www.vaccines.bizland.com/letters.htm 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 (.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 AFFIDAVIT I, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being, state Citizen of the Connecticut Republic. Be it known to all courts, governments, and other parties that: Being a person of Strong Christian Morals, it is against my Deep, Sincerely Held, Religious Convictions to accept the injection of any foreign substance into my Body or the Body of my 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 newborn's body. This written statement to exempt my newborn from any immunizations, newborn screening, and the Vitamin K shot, because I 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 conscientiously held religious beliefs and practices, and violates the free exercise of my religious principles. The Hepatitis-B vaccine 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. 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 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 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. 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 and that of my family that I can accept. I affirm that vaccination & injections of any foreign substances and proteins conflict with my religious beliefs as stated above. Therefore, I would request that you accommodate my religious beliefs and practices by exempting my newborn child from any vaccinations, injections and testing of any kind. Rest assured that my family and I 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 Connecticut 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___ 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 Daycare & Preschools: Same forms as school below. Schools: Religious Exemption Form (.pdf)
http://www.sde.ct.gov/sde/lib/sde/PDF/deps/student/health/Religious_Exemption.pdf
Medical Exemption Form AFFIDAVIT I, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being, state Citizen of the Connecticut Republic. Be it known to all courts, governments, and other parties that: Being a person of Strong Christian Morals, it is against my Deep, Sincerely Held, Religious Convictions to accept the injection of any foreign substance into my Body. 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. This written statement to exempt myself from the immunization requirement, and the Mantoux (PPD) Tuberculin Test, because I 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 conscientiously held religious beliefs and practices, and violates the free exercise of my 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 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 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. I, {First and Last name}, am exercising my rights under the First Amendment of the US Constitution and [insert Connecticut college exemption statute here] to receive Religious Exemption from Vaccination & 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 and that of my family that I can accept. I affirm that vaccination & injections of foreign proteins conflict with my religious belief as stated above. Therefore, I would request that you accommodate my religious beliefs and practices by exempting me from the college vaccination and TB testing requirement. Rest assured that I do practice a form of immunization that keeps my immune system 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 Connecticut 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___ 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. Immunization Exemption Form Vaccine Exemption Form Immunization Waiver Employment: US Fish and Wildlife Service Form 3-2283 Hepatitis B Immunization Consent/Refusal Form (.pdf)
http://www.fws.gov/forms/3-2283.pdfYou may use the AFFIDAVIT for Connecticut 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) Most of these are the Hepatitis B vaccine declination forms, such as the OSHA form. There are hundreds of these forms. Rather than linking to each one, here are the Google Search results for these keywords. There are other vaccines that one can decline that are worded like the OSHA forms. Vaccine Declination Form or Hep B vaccine waiver 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 Testing Exemption Letter: 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 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: http://www.theqxci.com/practitioners.php#ne 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 1-888-249-1421.
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