SOUTH DAKOTA - IMMUNIZATION EXEMPTIONS by State (includes current statutes, letters & forms)IMMUNIZATION EXEMPTIONS by State (includes current statutes, letters & forms)South Dakota Current Statutes & Laws: http://www.nvic.org/Vaccine-Laws/state-vaccine-requirements/southdakota.aspx Medical & Religious Submit a written statement signed by one parent or guardian that the child is an adherent to a religious doctrine whose teachings are opposed to such test and immunization.
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. IMPORTANT! Please download this if you're expecting a child or know someone who is! South Dakota Newborn Metabolic Screening Practitioners Manual http://www.state.sd.us/doh/NewbornScreening/NMS_Guide.pdf Refusal is allowed, but look what it says about Parent Refusal. "Parent Refusal – What if the parents refuse the screen?South Dakota Department of Health Office of Family Health Newborn Metabolic Screening Program Parental Refusal of Newborn Screen Refusal is Page 11. Be sure to turn in the refusal form along with the model birth plan letter and/or religious exemption affidavit. This proves to the hospital that refusal is allowed for newborn screening in South Dakota. Can and should use with the Model Birth Plan letters. The birth plan arrangements and letter should be turned in before delievery date. 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)."The package insert should be printed out and used along with the birth plan letter, the refusal form on page 11 of the manual (above...), and your exemption letter or AFFIDAVIT. This shows the hospital or birthing center that you are aware of the risks of Vitamin K injection, and that they should be too. 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 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. Hepatitis B Vaccine Refusal from Dr. Sherri Tenpenny's webpage: (.pdf) http://www.nmaseminars.com/files/Hep_B_in_the_hospital_1_.pdfThis form is generic. It can be used in other states. (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 AFFIDAVIT I/We, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being(s), state Citizen(s) of the South Carolina 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 SOUTH DAKOTA STATUES § 13-28-7.1 (2) 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/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 South Dakota 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___ SOUTH DAKOTA STATUES § 13-28-7.1 (2) A written statement signed by one parent or guardian that the child is an adherent to a religious doctrine whose teachings are opposed to such test and immunization; Some definitions for terms on AFFIDAVIT: Further Affiant Saith Not Affiant: a person who makes an affidavit. Saith: A third person singular present tense of say. Sui Juris: having full legal capacity to act on one's own behalf : not subject to the authority of another Propria Persona: In ones own proper person. 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. There is a section on the bottom of the South Dakota Immunization Form where exemptions are checked and signed. (.pdf) SD Certificate of Immunization front page.pdfThis is a scanned copy. You will need to pick up an original form. Daycare & Preschools: Vaccination Exemption Statement for South Dakota -- Exemption VacLib-SD.doc (.doc)
VaccineTruth.net/letters/ExemptionVacLib-SD.doc13-28-7.1. Tests and immunizations for communicable diseases required for admission to school or early childhood program--Exceptions--Rules. Any pupil entering school or an early childhood program in this state, shall, prior to admission, be required to present to the appropriate school authorities certification from a licensed physician that the child has received or is in the process of receiving adequate immunization against poliomyelitis, diphtheria, pertussis, rubeola, rubella, mumps, tetanus, and varicella, according to recommendations provided by the Department of Health. The Department of Health may modify or delete any of the required immunizations. As an alternative to the requirement for a physician's certification, the pupil may present: (2) A written statement signed by one parent or guardian that the child is an adherent to a religious doctrine whose teachings are opposed to such immunization. We, ____________________________, the parents of ____________________________, attest that it is against our strong Christian morals and beliefs that utilizing the aboved "immunizing" agents are against our religious doctrine. The Holy Bible contains several passages which tell us how to care for our bodies, being temples of the Holy Spirit and created in His image. The following are citations from the religious doctrine we utilize to justify our beliefs. Genesis 1:29-30 And God said, "See, I have given you every herb that yields seed which is on the face of the earth, and every tree whose fruit yields seed; to you it shall be for food. Also, to every beast of the earth, to every bird of the air, and to everything that creeps on the earth, in which there is life, I have given every green herb for food." We are to be holy which literally means to be clean. There is a saying that "cleanliness is next to godliness." Romans 12:1 "I beseech you therefore, brethren, by the mercies of God, that you present your bodies a living sacrifice, holy, acceptable to God, which is your reasonable service." Vaccines are not clean, containing pathogens cultured in diseased tissue of both animal and human origin, aluminum hydroxide, phenol (carbolic acid), thimerosal (49.6% ethyl mercury), formaldehyde, polysorbate 80 and other noxious ingredients that bypass the normal portals of entry by being injected directly into the body. 1 Corinthians 3:16-17 "Know ye not that ye are the temple of God, and that the Spirit of God dwelleth in you? If any man defile the temple of God, him shall God destroy; for the temple of God is holy, which temple ye are." Vaccines are foreign to the human body, unclean by Scripture definition, and injected into the body in a manner that is condemned by God in His Holy Word. Rest assured that we do practice a form of immunization that keeps our child's immune system strong and is in keeping with Biblical principles. However, our form(s) of immunization are also no guarantee that our son/daughter, ________________________, will not ever become ill, just as vaccination is no assurance that the vaccinated will not contract the very illness for which they are vaccinated against. Furthermore, we understand that should there be an outbreak of a communicable disease in the school among the vaccinated students, our son will not be allowed to attend school until the South Dakota Dept. of Health has determined that the outbreak is no longer a threat to the health and well being of the rest of the students. The above affidavit is submitted pursuant to our right to refuse vaccination for our minor son/daughter under South Dakota Codified Law §13-28-7.1 (2) Subscribed and sworn, without prejudice, and with all rights reserved. _________________________________ _______________________________ husband's name wife's name __________________________________________ Above letter in Microsoft Word (.doc)
Vaccination Exemption Pursuant to South Dakota Codified Law
Schools: (.doc)
Vaccination Exemption Pursuant to South Dakota Codified Law
Vaccination Exemption Statement for South Dakota -- Exemption VacLib-SD.doc (.doc)
VaccineTruth.net/letters/ExemptionVacLib-SD.doc
"WHAT DOES A VACCINATION EXEMPTION LETTER LOOK LIKE?" "Well, it might look a lot like the one my children used:" It is my sincerely held religious belief that immunization is detrimental to the health and purity of the body, mind and spirit. Therefore, I respectfully request that I, (full name here) be allowed to attend school, namely (full name and address here) without being immunized. ______________________________________ (student's name) __________________________ Mother _________________________ Father Sworn to before me this _________ th day of _________________, 20___. _____________________________________ Notary Public http://www.doctoryourself.com/news/v2n19.txt Opt-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: The University of South Dakota | Vermillion, SD 57069 | 877-COYOTES (.pdf)
http://www.usd.edu/shs/ExemptionForm.pdfAugustana C O L L E G E Check off exemption at bottom of page 2: (.pdf)
http://www.augustana.edu/campus/safety/docs/immunizationform.pdfAugustana C O L L E G E International Form (check off exempt on page 2) (.pdf)
http://www.augustana.edu/campus/safety/docs/internationalimmunizationform.pdfDakota State University – Graduate Office 820 North Washington – Madison, SD 57042 Medical Exemption on top of page 2 (.pdf)
REQUIRED IMMUNIZATION FORMSouth Dakota State University (.pdf)
http://studentaffairs.sdstate.edu/HealthandCounseling/ExemptRequestIR.pdfMOUNT MARTY COLLEGE | 1105 WEST 8TH STREET | YANKTON, SD 57078 CONSCIENTIOUS EXEMPTION at bottom of page (.pdf)
http://www.mtmc.edu/student/residence-life/files/health2.pdfSD Immu Form, Medical Exempt only, at bottom of page South Dakota School of Mines & Technology (.pdf) http://gesp.sdsmt.edu/forms/Immunization%20Form.pdf (.pdf)
http://www.hpcnet.org/upload/attachments/375423_20061030083600.pdf (.doc)
http://sdmines.sdsmt.edu/upload/attachments/375424_20061030083542.docUse the AFFIDAVIT for South Dakota Adult (college & employment religious exemption) below for religious exemption. AFFIDAVIT for South Dakota Adult (college & employment religious exemption) ... Edit as needed... AFFIDAVIT is available in Microsoft Word (.doc) and WordPerfect  (.wpd) format.
Contact us.AFFIDAVIT I, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being, state Citizen of the South Dakota Republic affirm: 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 South Dakota college exemption statute here, or leave blank for employment situations] 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 South Dakota 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___ The above AFFIDAVIT is available in Microsoft Word (.doc) and WordPerfect (.wpd) format.Click here to Contact Donna. 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: "Declination of Annual Influenza Vaccination" http://mylist.net/archives/mcoh-eh/2005-October/002984.html Copy and paste text into a word processing document. PDF sample on page 43 (.pdf)
http://www.shea-online.org/Assets/files/HCW_Flu_Position_Paper_FINAL_9-28.pdfMost 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: SD repeals TB skin test requirement for school children & school employees The 2005 South Dakota Legislature repealed the TB skin test requirement for school students (SDCL 13-28-7.1) and school employees (SDCL 13-43-3), effective July 1, 2005. New students and new employees will not be required to receive TB skin tests for the upcoming 2005-2006 school year. This TB skin test repeal was recommended by the South Dakota Department of Health because school students and school employees are at extremely low risk for TB. The Certificate of Immunization form for students and the School Employee Certification of Health form for employees will be revised to reflect these changes. http://www.state.sd.us/doh/TB/index.htm TB Testing Exemption Letter: HTMLSample Exemption Letter for TB testing. May be modified to your use. http://www.vaclib.org/letters/TBwaiverGen.htm Microsoft Word Document (.doc)Sample Exemption Letter for TB testing. May be modified to your use. http://www.vaclib.org/letters/TBwaiverGen.doc TB Testing Exemption Letter for Adults: Microsoft Word Document (.doc)Sample Exemption Letter for TB testing. May be modified to your use. http://www.vaclib.org/letters/TBTestingWaiverAdult.doc WordPerfect Document (.wpd)Sample Exemption Letter for TB testing. May be modified to your use. http://www.vaclib.org/letters/TBTestingWaiverAdult.wpd  PDF document (.pdf)Sample Exemption Letter for TB testing. http://www.vaclib.org/letters/TBTestingWaiverAdult.pdf Extra link from Dr. Sheri Tenpenny's webpage: (.pdf) http://www.nmaseminars.com/files/Exemption_for_TB_testing_1_.pdfLead Testing Exemption Letter: HTMLSample Exemption Letter for Lead testing. May be modified to your use. http://www.vaclib.org/letters/Lead_testing_waiverGen.htm Microsoft Word Document (.doc)Sample Exemption Letter for Lead testing. May be modified to your use. http://www.vaclib.org/letters/Lead_testing_waiverGen.doc The above TB and Lead exemption letters courtesy of Deirdre DeVane of Wash DC. Thank you Deirdre! The adult TB letters were edited by Sherri Tenpenny. Thank you Sherri! 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 South Dakota South Dakota BEST™ BioMeridian Practitioners: Please call contact below to find 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 South Dakota QXCI Practitioners: http://www.theqxci.com/practitioners.php#central 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. |
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