For additional help with exemptions, birth plan, etc questions: Check our
Vaccination Liberation State Chapterand other resource organizations located in your state.
If your state specific help is not available, Contact us.
- - - Available Exemptions - - -
Medical &
Religious
[NVIC] Quick Fact: “A request for a religious exemption from immunization requirements must be presented to the facility/school on the Department of Health’s Religious Exemption From Immunization form (DH 681 Form). The DH 681 Form is issued only by county health departments and only for a child who is not immunized because of his/her family’s religious tenets or practices. If a parent requests such an exemption, the county health department staff must use the current DH 681 Form, which has been signed by the parent affirming the written statement on the form that a religious conflict exists. This form must be issued upon request. No other information should be solicited from the parent or guardian.” Rule 64D-3.046,
Florida Administrative Code. Medical exemptions are also allowed.
Update:
64D-3.046 Immunization Requirements: Public and Nonpublic Schools, Grades Preschool, Kindergarten Through 12, and Adult Education Classes.
...
2. DH Form 681, Religious Exemptions for Immunizations (English/Spanish/Haitian-Creole) (July 2008),
incorporated by reference, available at DOH CHDs, must be signed by the local county health department medical director or designee.
The form is available for reference only online: Here.
If above link does not work and you can not find a more current link, we have archived a copy. Form681.pdf
Your Choice.
Join thousands of other pioneers in refuting the presumed authority the corporate government has over your life.
Break the presumptions by negating adhesion contracts. Find out if your state's corporate statutes actually apply to you.
Did you sign a contract binding you to adhere to their statutes? Not likely. To learn more,
go to this page. PDF documents (.pdf)
links to (USA States)
Exemptions, Process for Religious Exemption, Health Care Minors can Consent to and calls to action, petitions, etc.
Stand For Health Freedom
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.
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.
Birth Plans GENERAL INFORMATION (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...
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)
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.
Florida State specific information Medical Treatment Refusal
None at this time.
GENERAL INFORMATION (Medical Refusal Forms and Affidavit)
1. Make an informed choice as far ahead of birth as possible.
2. See the Black box warning in the
FDA Package Insert for the Injection.
3. Know your options: Pre-Birth Diet, Oral Vitamin K, or synthetic Vitamin K Injection.
GENERAL INFORMATION Vitamin K
Vitamin K Injection...
The Question of Vitamin K for Newborns
"Essentially all human infants are born with very low blood levels of vitamin K and, since low amounts of vitamin K crosses into breast milk, levels remain low for several weeks after birth in breastfed babies. The purpose of this natural, universal experience of low vitamin K levels in newborns is not known. ..."
"Mouse and epidemiologic studies indicate that the neonatal “deficiency” of vitamin K, which promotes cell turnover, may actually protect the developing fetus from damaging substances that “escape the primary placental screen.”
Read the rest of the article here:
http://www.thevaccinereaction.org/
The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert.
Warning
"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%
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.
Informed Consent Defense (2020 Pilot Survey)
Wonderful Graphs comparing various unvaccinated vs vaccinated disease rates for vaccines and Vitamin K at birth
PDF 4.8MB
Florida State specific information Hepatitis B
None at this time.
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)_________."
Eyedrops Florida
383.04 Prophylactic required for eyes of infants.
https://www.flsenate.gov/Laws/Statutes/2018/0383.04 Florida law regarding eye exams for babies
Section 383.04, F.S., specifies that: “Every physician, midwife, or other person in attendance at the
birth of a child in the state is required to instill or have instilled into the eyes of the baby within 1 hour
after birth an effective prophylactic recommended by the Committee on Infectious Diseases of the
American Academy of Pediatrics for the prevention of neonatal ophthalmia3. This section does not
apply to cases where the parents file with the physician, midwife, or other person in attendance at the
birth of a child written objections on account of religious beliefs contrary to the use of drugs. In such
case the physician, midwife, or other person in attendance. Penalties exist for violation of current
requirements.
Eyedrops: General
Some states require Prophylaxis against Gonococcal OPHTHALMIA NEONATORUM.
Florida State specific information New Born Screening
New Born Screening Florida
Florida Statutes concerning testing for newborns. Exemption from newborn screening allowed. Fla. Stat. Ann. 29 § 383.14
Fla. Stat. Ann. 29 § 383.14 includes an exemption to newborn screening requirements when parents or guardians of the child object.
The law requires that a written statement of such objection be presented to the physician or other person whose duty it is to administer and report
tests and screenings under this section. The law also requires that the department maintain a confidential registry of cases.
383.14 [not 383.014] (4) OBJECTIONS OF PARENT OR GUARDIAN .-- The provisions of this section shall not apply when the parent or guardian of the child objects
thereto. A written statement of such objection shall be presented to the physician or other person whose duty it is to administer and report tests and
screenings under this section.
Scroll Down for appropriate section
http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0300-0399/0383/0383.html
New Born Screening: General
U.S. states now require screening of newborn babies for specific diseases.
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!
To ALL who choose to partially vaccinate or NOT vaccinate their
children:
We (here in Idaho) are hearing more reports of schools and daycares across our state not
honoring legal and valid vaccine exemptions.
The following article contains very important information as to why you
do NOT want to sign AAP's (state adopted) exemption form:
http://childhealthsafety.wordpress.com/ ...
Older letter regarding exemptions in Idaho (similar to many states today)
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
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.
Black's Law Dictionary - Sixth Edition - the definition of Affidavit. This is the dictionary used by the American Bar Association and all
judges/magistrates/attorneys.
Affidavit - A written or printed declaration or statement of facts, made voluntarily, and confirmed by oath
or affirmation of the party making it, taken before a person having authority to administer such oath or affirmation.
[notary]
Warning: Any affidavit we supply is a suggestion or template for you to modify to fit your beliefs or understanding of facts. The
"facts" are those of the person signing the affidavit.
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
An Adult Affidavit, with Christian beliefs, is here. (MSDOC file)
Feel free to modify as needed.
Dr. Tenpenny had the following forms on her web site. (Now Archived) The forms are generic and may be used in any state. Check any references that might need updating.
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
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
DayCare State Form Required: Yes. DH Form #681, Certificate of Religious Exemption From Immunization is required and
and can be downloaded from the the internet. See links below:
Preschool State Form Required: Yes. DH Blue Form #681, Certificate of Religious Exemption From Immunization is required and
must be obtained from from a Florida health department. See letter below:
Kindergarten & Schools State Form Required: Yes. DH Blue Form #681, Certificate of Religious Exemption From Immunization is required and must be obtained from from a Florida health department. See letter below:
[Below is a suggested letter if you do not have a suitable form.]
CERTIFICATE OF EXEMPTION OF SCHOOL ENTRY MEDICAL EXAMINATION
Please be advised that the submission of the school-entry examination within one year prior to enrollment conflicts with our religious beliefs, convictions, tenets,
or practices and therefore I request that _________________________________________ be exempt from such pursuant to Florida State Statutes Title XLVIII, Chapter 1003.22.
________________________________ _______________ Parent or Guardian Date
Title XLVIII, Chapter 1003.22
1003.22(1) School-entry health examinations; immunization against communicable diseases; exemptions; duties of Department of Health.-- ...
(5) The provisions of this section shall not apply if:
(a) The parent of the child objects in writing that the administration of immunizing agents conflicts with his or her religious tenets or practices;
In accordance with Florida Statutes, Title XLVIII, Chapter 1003.22 which reads in part as follows:
(5) The provisions of this section shall not apply if:
(a) The parent of the child objects in writing that the administration of immunizing agents conflicts with his or her religious tenets or practices;
Under the Constitution of the United States we are granted "freedom of religion." I know of no law that requires one to belong to an organized church or religious sect to practice his sacred beliefs.
Please be advised and advise those concerned that I met the requirements under Title XLVIII, Chapter 1003.22.
Sincerely,
________________________________ _______________ Parent or Guardian Date
State Form Required: Yes. DH Blue Form #681, Certificate of Religious Exemption From Immunization
is required and must be obtained from from a Florida health department. See llinks to 681 above:
Embry-Riddle Aeronautical University
Daytona Beach, FL 32114
Hepatitis B and Meningococcal Meningitis Waiver
https://daytonabeach.erau.edu/-/media/files/daytona-beach/about/health-wellness/immunication-waiver.pdf
https://cdn2.hubspot.net/hubfs/206683/Resource%20PDFs%20and%20DOCs/Health%20Center/immunization_form.pdf?t=1533817469757
St. Leo University Immunization Exemption Form.
If after reading the facts about Meningitis and Hepatitis B you decline to receive these vaccines download
and sign the waiver found on the right side of the Immunization Form and return it to the Saint Leo Health
and Wellness Center in DeChantal Hall or fax direct to 352-588-8305.
Info for religious waiver to all vaccines
Florida Statutes – Title XLVIII K-20 Education Code
1001.64 Community college boards of trustees; powers & duties
(8)(g) Each board of trustees pursuant to s. 1006.53 shall adopt a policy in accordance with rules of the State Board of Education
that reasonably accommodates the religious observance, practice, and belief of individual students in regard to admissions,
class attendance, and the scheduling of examinations and work assignments
Certification from clergy, if applicable, is attached.
Good religious reasons...
This constitutes good reasons when a school or college asks for your religious reason on a form that says, state your reason here, attach rationale, letter from clergy/authority, 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 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 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.
1006.69 Section (2) Effective January 7, 2003, Florida statute 1006.69 Section (2) mandates that an individual enrolled who will be residing in on-campus housing shall provide documentation of vaccinations against meningococcal meningitis and hepatitis B unless the individual, if the individual is 18 years of age or older, or the individual’s parents, if the individual is a minor, declines the vaccinations by signing a separate waiver for each of these vaccines, provided by the institution, acknowledging receipt and review of the information provided.
Florida statute 1006.69 applies only to meningococcal meningitis and hepatitis B. The required documentation informs the postsecondary school, and thus the state, that the student has either been vaccinated for meningococcal meningitis and hepatitis B or has chosen to decline the vaccines.
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."
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."
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.
Next (below) in Misc are some QXCI and other practitioners. (If known.)
Misc Info and explanation of QXCI - Etc.
QXCI SCIO EPFX Overview
(The SCIO and the EPFX are the same device.
It is known as the EPFX in the USA and the SCIO world wide.)
Source:
energymedicinereview.com/qxci-scio-epfx.html [Now inactive]
Your Choice.
(.doc) 
(.pdf)