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
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.
(NVIC 2024) H.305
Authorizes duties for regulated occupations including pharmacy technicians to give certain vaccines to adults and some children
Status: ENACTED, Governor Phil Scott's veto overridden by House and Senate on 6/20/2023, effective date 6/20/2023
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.
Vermont State specific information Medical Treatment Refusal
Replace the paragraph (near bottom of page 1) of the generic AFFIDAVIT above with your state law as follows: [Make sure you replace with your name, status, and name of child.]
(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.
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
Vermont 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)_________."
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
Medical, religious exemptions: School Immunization Exemption Form from Vermont Department of Health
"Vermont’s School Immunization Regulations apply to any students in attendance at any public or
independent kindergarten, any elementary or secondary school and certain post-secondary schools."
Note: See the note below about changes. False advertising
some words in the Religious Exemption are clearly "advertising propaganda."
See Language below for suggestions.
Changes:
There were several changes made effective July 1, 2012.
Medical exemption form is no longer on the same form as the Philosophical and Religious exemption form. Now the Philosophical form no longer exists.
There was some language added to the Religious exemption form.
Many parents objected to the added language.
In November, the Vermont DOH relented and modified the requirements of what must be signed each year.
We suggest you may want to mark out some of the language on the exemption form.
Be on the alert for changes in the form.
See the NEWS and the Act 157 below for more information.
NEWS
November 29, 2012 Vt. vaccine exemption form relaxed after criticism
MONTPELIER, Vt. (AP) — The Vermont Health Department has softened a rule affecting parents who want to skip vaccinations for their children...
Parents now will only be required to say they have read the department's educational materials on vaccines, Dolan told the Legislative Committee on Administrative Rules.
They will have to sign a form each year that says:
"I have reviewed and understand the Required Parent Education Information developed by the Vermont Department of Health."
Committee members voted to accept the department's revised rules after the panel's chairman, Rep. Richard Marek, a Newfane Democrat and lawyer, said he believed the revisions described by Dolan addressed the constitutional concerns.
Article is no longer available. August 2018, the 2018-2019 Religious exemption form has the offensive language reinstated.
Act 157
No. 157 Page 2 of 7
Sec. 2. 18 V.S.A. § 1122 is amended to read:
§ 1122. EXEMPTIONS
(a) A Notwithstanding subsections 1121(a) and (b) of this title, a person
may remain in school or in the child care facility without a required
immunization:
(1) If the person, or, in the case of a minor, the person’s parent or
guardian presents a written statement, from form created by the department
and signed by a licensed health care practitioner authorized to prescribe
vaccines or a health clinic, or nurse stating that the person is in the process of
being immunized. The person may continue to attend school or the child care
facility as long as for up to six months while the immunization process is being
accomplished;
(2) If a health care practitioner, licensed to practice in Vermont and
authorized to prescribe vaccines, certifies in writing that a specific
immunization is or may be detrimental to the person’s health or is not
appropriate;, provided that when a particular vaccine is no longer
contraindicated, the person shall be required to receive the vaccine; or
(3) If the person, or, in the case of a minor, the person’s parent or
guardian states in writing annually provides a signed statement to the school or
child care facility on a form created by the Vermont department of health that
the person, parent, or guardian:
No. 157 Page 3 of 7
(A) has holds religious beliefs or philosophical convictions opposed
to immunization;
(B) has reviewed and understands evidence-based educational
material provided by the department of health regarding immunizations,
including information about the risks of adverse reactions to immunization;
(C) understands that failure to complete the required vaccination
schedule increases risk to the person and others of contracting or carrying a
vaccine-preventable infectious disease; and
(D) understands that there are persons with special health needs
attending schools and child care facilities who are unable to be vaccinated or
who are at heightened risk of contracting a vaccine-preventable communicable
disease and for whom such a disease could be life-threatening.
(b) The health department may provide by rule for further exemptions to
immunization based upon sound medical practice.
(c) A form signed pursuant to subdivision (a)(3) of this section and the fact
that such a form was signed shall not be:
(1) construed to create or deny civil liability for any person; or
(2) admissible as evidence in any civil
Language on Religious Exemption Form
Statements on the form:
"This form may not be altered."
In signing this form, I attest to holding religious beliefs opposed to immunizations. I acknowledge that I have
reviewed the evidence-based educational material provided by the Vermont Department of Health regarding
immunizations, including:
• Information about the risks of adverse reactions to immunization;
• Information that failure to complete the required vaccination schedule increases risk to the child and to
others of contracting, carrying or spreading a vaccine-preventable infectious disease; and
• Information that there are persons with special health needs attending schools and child care
facilities unable to be vaccinated, or who are at heightened risk of contracting a vaccine-preventable
communicable disease, and for whom such a disease could be life-threatening.
Suggestions for how to alter the language of the form.
In signing this form, I attest to holding religious beliefs opposed to immunizations vaccinations.
I acknowledge that I have
reviewed the faith evidence-based educational material provided by the Vermont Department of Health regarding
immunizations, including:
• Information about the risks of adverse reactions to immunizations vaccinations;
• InformationClaims that failure to complete the required vaccination schedule increases risk to the child and to
others of contracting, carrying or spreading a vaccine-preventable infectious disease; and
• Information that there are persons with special health needs attending schools and child care
facilities unable to be vaccinated, or who are at heightened risk of contracting a vaccine-preventable
communicable disease, and for whom such a disease could be life-threatening.
immunizations, evidence-based, educational and information
Suggest you cross out certain words and replace them with the following:
immunizations cross out and write above or after: vaccinations
evidence-based educational material write above evidence faith and black out "education"
Information cross out and write over it Claim
Last sentence, cross out "vaccine-preventable".
The referenced words have been given a dark background to enable easy finding.
18 V.S.A. § 1123If 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.
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.
ATTACHMENT C - Hepatitis B Vaccine Declination
I understand that due to my occupational exposure to blood or other potentially
infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection.
I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no
charge to myself. However, I decline hepatitis B vaccination at this time. I
understand that by declining this vaccine, I continue to be at risk of acquiring
hepatitis B, a serious disease. If in the future I continue to have occupational
exposure to blood or other potentially infectious materials and I want to be
vaccinated with hepatitis B vaccine, I can request and receive the vaccination
series at no charge to me.
https://humanresources.vermont.gov/ pdf
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)