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: "Quick Fact: No child whose parent or guardian states in writing that vaccination or immunization conflicts with his sincere religious beliefs shall be required to present an immunization certificate in order to be admitted to school. Medical exemptions are also allowed."
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.
Massachusetts State specific information Birth Plans
None at this time.
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.
Massachusetts State specific information Medical Treatment Refusal
None at this time.
GENERAL INFORMATION (Medical Refusal Forms and Affidavit)
Massachusetts State specific information Vitamin K
None at this time.
Summary:
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
Massachusetts 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)_________."
Massachusetts State specific information New Born Screening
U.S. states now require screening of newborn babies for specific diseases.
Religious Exemption from newborn screening allowed. Mass. Gen. Laws ch. 111 § 110A
May I refuse these tests?
Most states have specific laws regarding newborn screening. In Massachusetts you may refuse for religious reasons. If you do so, you may be asked to sign a refusal form. This form relieves your doctor of liability for damages that result from a disorder that could have been detected by screening.
Chapter 111: Section 110A Tests of newborn children for treatable disorders or diseases Section 110A. The physician attending a newborn child shall cause said child to be subjected to tests for phenylketonuria, cretinism and such other specifically treatable genetic or biochemical disorders or treatable infectious diseases which may be determined by testing as specified by the commissioner. The commissioner may convene an advisory committee on newborn screening to assist him in determining which tests are necessary. The department shall make such rules pertaining to such tests as accepted medical practice shall indicate. The provisions of this section shall not apply if the parents of such child object thereto on the grounds that such test conflicts with their religious tenets and practices.
Statute: Sec. 67F. Such test shall not be performed if the parents or guardian of the newborn infant object to the test based upon the sincerely held religious beliefs of the parent or guardian. [Source: Chapter 243 of the Acts of 1998]
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: NO
1) a medical exemption is allowed if a physician submits documentation attesting that an
immunization is medically contraindicated; and
2) a religious exemption is allowed if a parent or guardian submits a written statement that
immunizations conflict with their sincere religious beliefs.
Preschool
See below under schools for a suggested letter:
Kindergarten & Schools
1) a medical exemption is allowed if a physician submits documentation attesting that an
immunization is medically contraindicated; and
2) a religious exemption is allowed if a parent or guardian submits a written statement that
immunizations conflict with their sincere religious beliefs.
[Short Form]
Notice of Religious Exemption to Vaccinations
To whom this may concern,
We, parents names, are exempting our child, (child's name,)___________________ from all vaccinations because it conflicts with our
sincerely held religious belief.
Exceptions: MGL 76, &15.
1) Upon certification that a doctor has personally examined the child and found "that his health would be endangered by such vaccination or by any of such immunizations."
2) No "child whose parent or guardian states in writing that vaccination or immunization conflicts with sincere religious beliefs
shall be required to present" the certificate in order to be admitted.
Exemption does not require the objecting persons to be a member of a recognized church or religious denomination.
Dallo v. Board of Education, 358 Mass 753, 267 NE 2d 219
220.500: Immunization Requirements for Preschool, Elementary, Middle and High School Students
(C) The requirements in 105 CMR 220.500 (A) and (B) shall not apply:
upon presentation of written documentation that the student meets the standards for medical or religious exemption set forth in M.G.L. c. 76, ss 15;
upon presentation of appropriate documentation, including a copy of a school immunization record, indicating receipt of the required immunizations;
in the case of measles, mumps, rubella and hepatitis B, upon presentation of laboratory evidence of immunity; or
in the case of varicella, upon presentation of laboratory evidence of immunity or a statement signed by a physician that the student has a history of chickenpox disease.
220.600: Immunization Requirements for Postsecondary Students
Here are the laws that pertain to Post Secondary Schools (colleges and universities)
They are in PDF and .RTF format, as PROOF that your son is allowed religious exemption. It should be downloaded and printed out. (.pdf)
https://www.mass.gov/doc/105-cmr-220-immunization-of-students-before-admission-to-school/download (.rtf) http://www.mass.gov/eohhs/docs/dph/regs/105cmr220.rtf
(Religious exemption is mentioned on page 2)
220.600:(D) The requirements of 105 CMR 220.600 shall not apply where the student meets one of the
criteria set forth in 105 CMR 220.500(C)
220.500: (C) The requirements in 105 CMR 220.500(A) shall not apply where:
(1) the student, or the student’s parent or guardian if the student is a minor, provides written
documentation that he or she meets the standards for medical or religious exemption set
forth in M.G.L. c. 76, § 15;
M.G.L. - Chapter 76, Section 15c
https://malegislature.gov/laws/generallaws/parti/titlexii/chapter76/section15c
In the absence of an emergency or epidemic of disease declared by the department of public health, no student who states in writing
that such immunization would conflict with his religious beliefs shall be required to present
such medical certificate in order to be admitted to such institution.
(CMR = Code of Massachusetts Regulations)
(Exemption Information)
Suggested letter follows:
Notice of Religious Exemption to Vaccinations
NAME of SCHOOL ____________________________
As per General Laws of Massachusetts chapter 76, section 15C (Vaccination and Immunization;
Exceptions by Reason of Physical Condition or Religious Belief) I am exempting myself from vaccination because it
conflicts with my sincerely held religious belief.
Title 105 CMR 220.600: Immunization Requirements for Postsecondary Students
...
(D) The requirements of 105 CMR 220.600 shall not apply where:
(1) the student provides written documentation that he or she meets
the standards for medical or religious exemption set forth in M.G.L. c. 76, § 15C;
Sincerely,
_____________________ ________________
Name/Signature of Student
Emerson College Center for Health and Wellness
Links to Health Forms and Medical/Exemption forms
Health Forms
Fitchburg State College - 160 Pearl St., Fitchburg MA
MDPH Meningococcal Information and Waiver Form
Waiver for Students at Residential Schools and Colleges
Waiver on page 2 (.pdf) https://www.fitchburgstate.edu/
MIT Medical Health Screening
Room E23-177
77 Massachusetts Ave.
Cambridge, MA 02139-4307
Fax: 617-253-4121
Pine Manor College now under Boston College
MDPH Meningococcal Information and Waiver Form
Waiver for Students at Residential Schools and Colleges
Waiver on page 2 (.pdf)
https://www.bc.edu/ ... pdf
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. States can only go against this if they can prove a compelling state interest is at stake. But recent court decisions have upheld the rights of individuals seeking exemptions from immunizations based upon "personal" religious beliefs. [Sherr and Levy vs. Northport East-Northport Union Free School District, 672 F. Supp. 81, (E.D.N.Y., 1987); Allanson vs. Clinton Central School District, U.S.. District Court, Northern District Court, Northern District of New York (84 CV 174), 1984; Campain vs. Marlboro Central School District, Supreme Court Ulster County Special Term, November 15, 1985; Brown vs. City School District, 429 NYS2d 355; Maier vs. Besser, 73 Misc.2d 241].
On the U.S. Supreme Court level in Frazee v. Illinois Dept. of Security, 489 U.S. 829, 1989, it was found that a state may not deny an exemption simply because a person is not a member of a formal religious organization. In addition, the Supreme Court has noted that nontraditional beliefs, including secular humanism, atheism, and nontheistic faiths, are all "religion" for the purpose of free exercise analysis. The Supreme Court in Fowler v. Rhode Island, 345 U.S. 67 (1953) held that it was "no business of the courts to say what is a religious practice or activity for one group is not religion under the protection of the First Amendment."
Section 15C.No full-time student under thirty years of age or any full-time or part-time undergraduate or graduate students in a health science who is in contact with patients shall, except as hereinafter provided, be registered at an institution of higher education except upon presentation of a medical certificate that such student has been immunized against measles, mumps, rubella, tetanus and diphtheria; provided, however, that a student may be registered at such institution upon certification made, in writing, by a physician who has personally examined such student and in whose opinion the physical condition of such student is such that his health would be endangered by any such immunization; and provided, further, that students who have attended an elementary or secondary school in the commonwealth may submit a copy of their school immunization record, indicating receipt of the above required immunizations, in lieu of such certificate; and provided, further, that unimmunized students may be registered on the condition that the required immunizations be obtained within ten days of registration.
In the absence of an emergency or epidemic of disease declared by the department of public health, no student who states in writing that such immunization would conflict with his religious beliefs shall be required to present such medical certificate in order to be admitted to such institution.
* Nowhere in the above text does it mention that a letter from clergy is required.
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."
Massachusetts State specific information TB Testing
Not at this time
General Information: TB and/or Lead Testing
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) 
(.rtf)