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
From NVIC link above
A school child may not be required to undergo any immunization when the child's parent objects on religious grounds.
A religious objection must be: (1) Made in writing;
(2) Signed by the child's parent; and
(3) Delivered to the child's teacher or to the individual who might order an immunization.
Medical exemptions are also allowed.
Updates/News
(NVIC 2024)
HB 1182 Makes changes to controlled substance list; Expanded list of vaccines pharmacist authorized to administer to include all CDC/ACIP vaccines removed
Status: ENACTED, Signed by Governor Eric J. Holcomb on 3/12/2024; Public Law 84; Effective Date 7/1/2024
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.
Indiana 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
Indiana 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)_________."
Indiana State specific information New Born Screening
New Born Screening Religious Exemption from newborn screening allowed.
Ind. Code 16-41-17-2(d) IC 16-41-17-2 Examinations; religious exemption
Sec. 2. (a) Subject to subsection (d), every infant shall be given
examinations at the earliest feasible time for the detection of the
following disorders:
...
(d) If a parent of an infant objects in writing, for reasons
pertaining to religious beliefs only, the infant is exempt from the
examinations required by this chapter.
In accordance with Ind. Code 16-41-17-2, subsection (d), I certify that the newborn screening to my child, ________________________, is contrary to ________________________ my personal religious beliefs,
held either individually or jointly with others, and I therefore request that my child be exempt from the newborn screening and examinations of IC 16-41-17-2.
17. What should we do if a family signs the religious waiver just to avoid the screen?
The only accepted reason to waive a screening is due to true religious beliefs and the parents have the right to sign the religious waiver form without question from hospital personnel. When this occurs; however, hospitals are responsible to educate the family on the importance of the hearing screen and assure them of the screening procedure. This will often lead to compliance for the screening if the refusal is not truly due to religious beliefs. If the family still refuses the screening, record the infant in the Reason Codes section of the Monthly Summary Report and send a copy of the signed religious waiver to ISDH with the MSR. IC 16-41-17-2
Statute: Sec. 2. (c) If a parent of an infant objects in writing, for reasons pertaining to religious beliefs only, the infant is exempt from the examinations required by the chapter. [Source: HB 1410, 1999]
In accordance with Ind. Statute: Sec. 2. (c) I certify that the hearing screening to my child, ________________________, is contrary to ________________________ my personal religious beliefs, held either individually or jointly with others, and I therefore request that my child be exempt from the hearing screening and examinations of Ind. Statute: Sec.2. (b).
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
State Form Required: No. A religious objection must be made in writing, signed & delivered to teacher or individual who ordered immunizations.
DayCare IC 12-17.2-4 Chapter 4. Regulation of Child Care Centers
IC 12-17.2-4-18.1
(b) A licensee meets the requirement of subsection (a) if:
(1) a child's parent:
(A) objects to immunizations for religious reasons; and
(B) provides documentation of the parent's objection;
(2) the child's physician provides documentation of a medical
reason the child should not be immunized; or
(3) the child's physician provides documentation that the child
is currently in the process of receiving complete age appropriate
immunizations;
https://www.in.gov/fssa/carefinder/files/IC-12-17.2-4-reg-of-child-care-centers.pdf
Kindergarten & Schools
Exemption Information - Religious Exemption - statement by parent required, see instructions under Exemption Information.
see IC 21-40-5-4 Exemption from immunization
and IC 21-40-5-6 Religious objections
section-21-40-5-4/ |
Higher Education § 21-40-5-6
2022 CHIRP School Nurse Training Guide Indicating a Student is Exempt from Immunization
In Indiana, students may be exempt from receiving immunizations for two reasons: a medical exemption
or a religious objection. Philosophical objections are not permitted. The exemption/objection is noted
on the same screen as the Patient Detail screen used in the above procedure. See Page 6.
Nov 2022 CHIRP School Nurse Training Guide.pdf
Sec. 6. (a) Except as otherwise provided, a student may not be required to undergo testing, examination, immunization, or treatment required under this chapter when the student objects on religious grounds.
(b) A religious objection does not exempt a student from testing, examination, immunization, or treatment required under this chapter unless the request for an exemption is:
(1) made in writing;
(2) signed by the student; and
(3) delivered to the individual who might order a test, an examination, an immunization, or a treatment absent the religious objection.
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]