VERMONT - IMMUNIZATION EXEMPTIONS by State (includes current statutes, letters & forms)IMMUNIZATION EXEMPTIONS by State (includes current statutes, letters & forms)Vermont Current Statutes & Laws: http://www.nvic.org/Vaccine-Laws/state-vaccine-requirements/vermont.aspx Medical, Religious & Philosophical If the person, or in the case of a minor the person's parent or guardian states in writing that the person, parent or guardian has religious beliefs or moral convictions opposed to immunization the child will be exempt.
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. Vermont: HIV Testing for Mothers and Newborns, 2002 Voluntary HIV testing; no specific law. State follows CDC guidelines; No specific law or language on testing for mothers and newborns. 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, 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. This "Refusal to Permit Medical Treatment" form is optional to use. "Refusal to Permit Medical Treatment" form Refusal to Permit Medical Treatment. A generic form. (.pdf) ../letters/refusal_treatment.pdf
It would be good idea to use with the AFFIDAVIT AND model birth plan letter (below). 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 AFFIDAVIT I/We, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being/s, state Citizen/s of the Vermont Republic. Be it known to all courts, governments, and other parties that: Being a person/or 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/our Body/Bodies or the Body/Bodies of my/our 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/our newborn’s body. This written statement to exempt my/our newborn from any immunizations, the Vitamin K shot, eye prophylaxis, PKU & other testing because I/we hold genuine and sincere personal religious beliefs which are inconsistent with these medical procedures & experimentation. The practice of vaccination, injections and 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 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/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)."(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 and V.S.A. § 1122 (3) 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/our body/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 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 vaccination or injections of any kind. Rest assured that my/our family and I/we 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 Vermont 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. 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.pdf (.doc) http://www.nmaseminars.com/files/SampleVaccineExemptionForm.docTo be used for pediatricians and doctors as opposed to the incriminating Refusal To Vaccinate form. State Form Required: No. Generic form, letter or affidavit may be used. Daycare & Preschools: V.S.A. § 1122 (3) If the person, or in the case of a minor the person's parent or guardian states in writing that the person, parent or guardian has religious beliefs or moral convictions opposed to immunization. (.pdf) Childcare Immunization Exemption FormSTATE OF VERMONT SCHOOL IMMUNIZATION EXEMPTION FORM (.pdf) http://www.ccsvt.us/photofiles/healthoffice_VTImmunizationExemptionForm.pdf (.doc) ExemptionVacLib-Vermont.doc
Alternative link... (.doc) Exemption VacLib-Vermont.docThe above Exemption form is available in PDF format  (.doc) and WordPerfect (.wpd) format.Click here to Contact Donna. Schools: V.S.A. § 1122 (3) If the person, or in the case of a minor the person's parent or guardian states in writing that the person, parent or guardian has religious beliefs or moral convictions opposed to immunization. Halifax School 246 Branch Road West Halifax, Vermont 05358 (.pdf) Vermont Dept of Health School Immunization Exemption Form 2.8.2008.pdf (This form is generic and can be used for any school in the state) Charlotte Central School 408 Hinesburg Road, Charlotte, VT 05445 STATE OF VERMONT SCHOOL IMMUNIZATION EXEMPTION FORM (.pdf) http://www.ccsvt.us/photofiles/healthoffice_VTImmunizationExemptionForm.pdfIt's a generic form, so it may be used for other schools and also colleges. VERMONT DEPT OF HEALTH SCHOOL IMMUNIZATION EXEMPTION FORM (.pdf) http://healthvermont.gov/hc/imm/documents/IZ_School_Immunization_Exemption_Form.pdf (.doc) ExemptionVacLib-Vermont.doc
Alternative link... (.doc) Exemption VacLib-Vermont.docThe above Exemption form is available in PDF format (.doc) and WordPerfect (.wpd) format.Click here to Contact Donna. Summer Camps/Day Camps: Smirkus Camp, 1 Circus Road, Greensboro, VT 05841 SMIRKUS CAMP 2008. IMMUNIZATION EXEMPTION FORM 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: V.S.A. § 1122 (3) If the person, or in the case of a minor the person's parent or guardian states in writing that the person, parent or guardian has religious beliefs or moral convictions opposed to immunization. (.pdf) Middleburg College 2008 Immunization Exemption Form (.pdf) UNIVERSITY OF VERMONT IMMUNIZATION EXEMPTION FORMSTATE OF VERMONT SCHOOL IMMUNIZATION EXEMPTION FORM (.pdf) http://www.ccsvt.us/photofiles/healthoffice_VTImmunizationExemptionForm.pdfSince this form is generic, it can be uesd for colleges. This AFFIDAVIT below is also sufficient for a religious exemption statement from MMR and any other vaccines to post secondary institutions. Most colleges now have their mandatory waiver for meningitis. The required documentation informs the postsecondary school, and thus the state, that the student has either been vaccinated for meningococcal meningitis or has chosen to decline the vaccine. AFFIDAVIT I, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being, state Citizen of the Vermont 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/our) (Body/Bodies) (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/our) (body/bodies) (or any of my children’s bodies). This written statement to exempt (me/us) from any immunizations, Mantoux (PPD) Tuberculin (TB) Test, or other shots/injections, because I hold genuine and sincere personal religious beliefs which are inconsistent with these medical procedures & 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 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. The Chickenpox (Varivax) vaccine contains MRC-5 and RA 273. 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 promote 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/our) faith. (I/We), {First and Last name(s)}, (am/are) exercising (my/our) rights under the First Amendment of the US Constitution 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 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 (me/us) from any vaccination or injections 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 Vermont 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: V.S.A. § 1122 (3) If the person, or in the case of a minor the person's parent or guardian states in writing that the person, parent or guardian has religious beliefs or moral convictions opposed to immunization. May use the above AFFIDAVIT COLCHESTER SCHOOL DISTRICT HEPATITIS-B VACCINATION DECLINATION FORM Page 12 (.pdf) http://www.colchestersd.k12.vt.us/Policies/f11.pdf
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: 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 request a printout with the results. Here are some of the practitioners for Vermont Vermont 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 Vermont QXCI Practitioners: Premrup Streiker, M.S.W.; M. Ed. EPFX / QXCI Practitioner, Counselor, Intuitive Mediation, Emotional Depth Work, Energy Block release, Heightened Awareness, Chronic Physical Illness Fees: $150 Initial Session $75 per hour after initial session $1150 for 10 prepaid Sessions Bonita Springs, Florida Sun Valley, Idaho Manhattan, Upstate New York Brattleboro, Vermont 208-578-1265 (Idaho) 212-675-6529 (New York) 239-949-1746 (Florida) 208-720-6880 (cell) premrup@mindspring.com Web Address: www.quantumpremrup.com http://www.theqxci.com/practitioners.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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