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Vaccination Liberation Information
Florida State Exemption Page
VacLib.org & VaccineTruth.net Exemption Page

Click for the desired information for your state

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Statues/Laws
Link to state law.
National Vaccine Information Center:
Link to state law.

For additional help with exemptions, birth plan,etc questions:
Check our Vaccination Liberation State Chapter and other resource organizations page for help in your state.

If your state specific help is not available, Contact us.

Available Exemptions
Medical  &  Religious

Religious Exemption requests must be presented on DH Form 681, Religious Exemption From Immunization, which is to be issued only by county health departments.
PDF documents (.pdf)

A PDF reader is required for PDF Files:
Free Foxit Reader 12 MB file size.

Or Free Download of Acrobat Reader: [Adobe. 43 MB file size]

Click for the desired information for your state

New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: Schools  |   DayCare  |   Preschool  |   K-12  |   College  |   (options) OptOutRegistry  |  
Adult Issues: Employment  |   TB_and/or_LeadTesting
Statues/Laws  |   Waivers_CareInSigning  |   Misc_Info, QXCI providers, Sponsors, etc.

NewBorn Birthing Plan and Birth Exemptions
BirthExemptions  |   Birthing_Plans  |   Vitamin_K  |   Hepatitis_B  |   Eyedrops  |   Newborn_Screening

Birth Exemptions:

For those who are planning a hospital birth but want to evade invasive routine post natal procedures such as a Hep B shot, vitamin K injection, newborn screening, or the application of silver nitrate in the newborn's eyes, a very specific birthing plan must be submitted to the hospital in advance of the birth. Hospital staff must be informed, in advance, of your needs, wants and desires where your baby and birthing experience are concerned. The same applies to midwives.

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.

  • The "Refusal to Permit Medical Treatment" form below is optional.
Birth Plans (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...

Information on the Dangers of Hospital Birth and the Benefits of Home Birth from gentlebirth.org

Our best and most itemized birthplan:
Word-Document (.doc) birthplan-itemized.doc  |   PDF-Document (.pdf) birthplan-itemized.pdf

(HTML) BirthPlan-Itemized for reading on screen. Includes handy small dictionary of terms in the document.

Word-Document (.doc) Model Letter for Hospital Births (Model11425.doc)

Model Birth Plan Letter for Hospital Births. This one is more detailed.

Word-Document (.doc) Model letter for hospital births 2.doc (11426)

Model Birth Plan Letter for Hospital Births for an adopted child...
Model letter for hospital births for adoptions -- Dear Doctor and Medical Staff.doc (11427)
Word-Document (.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.

"Refusal to Permit Medical Treatment" form
A generic form.
PDF-file (.pdf) letters/refusal_treatment.pdf

It would be good idea to use the AFFIDAVIT below AND a model birth plan letter from above above.
Affidavit - Birth Exemptions
HTML (simple text) Affidavit to modify.

AFFIDAVIT in Microsoft Word Word-Document (.doc) format. (may be modified)

"... are exercising our rights under the First Amendment of the US Constitution and Florida Statutes 1003.02, 402.305, 402.313 and 383.14 (4) to receive Religious Exemption from Vaccination, ALL injections, & testing."

If your Title and Paragraph number of your state law is not pasted above, click here for the link to your state law.
Vitamin K Injection...

The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert.
http://fdb.rxlist.com/drugs/drug-9003-Aqua-Mephyton+Inj.aspx?drugid=9003&drugname=Aqua-Mephyton+Inj
"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%

Links to prescribing information for Vitamin K:
http://vaclib.org/chapter/inserts.htm#vitK

Archive: Year 2002 Merck Vitamin K Package Insert - Aquamephyton PI | posted on Scribd

Alternatives to Vitamin K Prophylaxis...

Although oral vitamin K is not licensed for use as a drug by the FDA, drops for oral administration are available. Typically, one drop contains 2 mg. of vitamin K. Contact a midwife in your area, or a birthing supply company (such as birthwithlove.com), or Scientific Botanicals (206 527-5521) where your health care provider can order liquid vitamin K directly.

Here's another much safer alternative that your chiropractor or naturopath can order for you.

http://www.bioticsresearch.com/Products/BioK.htm

A good organic whole food diet along with lots of leafy green vegetables is all that is necessary to prevent vitamin K deficiency in newborns.

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 do get a signature, hold on to the form.

See Birth Plans for more information on avoiding Hep B Vaccination at birth
Eyedrops
Florida
Regarding Eye Prophylaxis...
http://www.flsenate.gov/data/session/2005/House/bills/analysis/pdf/h1055.HCG.pdf
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.

USA General
Some states require Prophylaxis against Gonococcal OPHTHALMIA NEONATORUM.

A discussion of medical and legal issues regarding Silver Nitrate in the eyes of the newborn is here:
PDF file: Statutory Law USA: Requiring Silver Nitrate in Eyes of Newborns at: http://www.rbs2.com/SilvNitr.pdf
Written by Dr. Ronald B. Standler, attorney in Massachusetts and consultant

Blog type discussion of pros and cons of eyedrops for newborn is here: http://answers.google.com/answers/threadview/id/20050.html

New Born Screening
Florida


Florida Statues 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
(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.
http://www.flsenate.gov/laws/statutes/2010/383.14

USA General
U.S. states now require screening of newborn babies for specific diseases.

Conditions and legal status of "requirement" of newborn to be screened for each state:
National Newborn Screening Status Report - http://genes-r-us.uthscsa.edu/nbsdisorders.pdf

Newborn Genetic Screening Privacy Laws
(includes links to laws for various states)
ncsl.org/IssuesResearch/Health/NewbornGeneticandMetabolicScreeningLaws/tabid/14416/Default.aspx

Newborn screening From Wikipedia, the free encyclopedia
http://en.wikipedia.org/wiki/Newborn_screening

Federal NewBorn Screening Law (from Families of Spinal Muscular Atrophy)
http://www.fsma.org

Click for the desired information for your state

New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
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Waivers - Take Care In Signing
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!

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

AAPmodified.doc MSWord .DOC file  |   AAPmodified.pdf PDF file, best for printing.

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.

See:   AnaiRhoads.org Why Signing a Waiver to Avoid Vaccines Can Be Considered Abuse
She is referring to the Refusal To Vaccinate Form developed by The American Academy of Pediatrics, not a regular religious or conscientious exemption letter or form.


Click for the desired information for your state

New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: Schools  |   DayCare  |   Preschool  |   K-12  |   College  |   (options) OptOutRegistry  |  
Adult Issues: Employment  |   TB_and/or_LeadTesting
Statues/Laws  |   Waivers_CareInSigning  |   Misc_Info, QXCI providers, Sponsors, etc.

Letters Forms Affidavits
Links to Model birth plan letters (above).

Link to Refusal to Permit Medical Treatment form

Links to Affidavit - Birth

An Adult Affidavit, with Christian beliefs, is here. (MSDOC file) Feel free to modify as needed.

Dr. Tenpenny has the following forms on her web site. The forms are generic and may be used in any state.

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

http://drtenpenny.com/vac_refusal_forms.aspx

Sample Vaccine Letters. from www.vaccines.bizland.com/letters.htm archived on VacLib.org/letters/doctor.htm

Short Sample Vaccine Letter

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

Religious exemption forms will be listed below under Daycare Schools Colleges

Click for the desired information for your state

New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
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Adult Issues: Employment  |   TB_and/or_LeadTesting
Statues/Laws  |   Waivers_CareInSigning  |   Misc_Info, QXCI providers, Sponsors, etc.

DayCare - Preschool - Schools - Colleges
DayCare-Preschool-K-12-Colleges
DayCare  |   Preschool  |   K thru 12  |   Colleges
DayCare
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:

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:

Information about the FL Religious Exemption, Legal Exemptions, your Rights, and sample Religious Exemption forms, College Waiver. http://www.know-vaccines.org/?page_id=127


Letters for requesting form #681
The following letters & statements may be used to pick up the form #681.

(Date)

(Name of County Health Department Director)
(Name of County Health Department)
(Address of County Health Department)
(City, State, Zip code)

REF: Submission for Religious Exemption from Vaccination (DH Blue Form #681) for:
(Full name of Child, Date of birth); (list any other children and dates of birth)

Dear (name of Director or designee):

(We / I) {First and Last name(s)}, as the {(parent (s) / guardian(s)} of the above named child (ren) are exercising our rights under the First Amendment of the US Constitution and Florida Statutes 1003.02, 402.305, and 402.313 to receive Religious Exemption from Vaccination.

(We / I) am fully aware of the risks of not vaccinating as described by the Centers for Disease Control, The American Academy of Pediatrics, and the American Medical Association.

However, (we/I) have sincere religious beliefs that prohibit us from submitting to and receiving vaccinating agents.

In addition, (we / I) further request a letter to School Administrators resolving its failure to include the legal rights of a parent or student to a religious exemption as outlined in the Florida Statute. (We/I) will seek legal action if, due to the failure on the part of the State of Florida to recognize these rights, (our/my) (child/children) (is/are) not admitted to a Florida school or daycare.

If the certificate of exemption must be signed at the Health Department, please provide a written notice of appointment, with five working days advance response permitted.

Respectfully,

{Name(s)}
(Mailing Address)
(City, State, Zip code)

A Florida School who has their own religious exemption form
(Private) Morning Star School ~ 104 NW 7th Street ~Boynton Beach, FL 33426 ~ 561-737-4807
http://www.hsconnexion.com/morningstarschool/pdf2/vi_exemption.pdf

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 School-entry health examinations; immunization against communicable diseases; exemptions; duties of Department of Health.--

(1) Each district school board and the governing authority of each private school shall require that each child who is entitled to admittance to kindergarten, or is entitled to any other initial entrance into a public or private school in this state, present a certification of a school-entry health examination performed within 1 year before enrollment in school. Each district school board, and the governing authority of each private school, may establish a policy that permits a student up to 30 school days to present a certification of a school-entry health examination. Children and youths who are experiencing homelessness and children who are known to the department, as defined in s. 39.0016, shall be given a temporary exemption for 30 school days. Any district school board that establishes such a policy shall include provisions in its local school health services plan to assist students in obtaining the health examinations. However, a child shall be exempted from the requirement of a health examination upon written request of the parent of the child stating objections to the examination on religious grounds.

(2) The State Board of Education, subject to the concurrence of the Department of Health, shall adopt rules to govern medical examinations and immunizations performed under this section.

(3) ...

(4) ...

(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;

FREEDOM OF RELIGION STATEMENT


To Whom It May Concern:

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

Colleges/Universities
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: http://www.know-vaccines.org/?page_id=127 Sample letters

Embry-Riddle Aeronautical University
Daytona Beach, FL 32114
MMR Waiver
http://www.erau.edu/db/health/Immunization-Waiver-09.pdf
Hepatitis B and Meningococcal Meningitis Waiver
http://www.erau.edu/db/health/Immunization-Waiver-11.pdf

St. Leo University Immunization Exemption Form.
Statement of Exemption to Immunization Law
http://www.saintleo.edu/Documents.ashx?id=870

Certification from clergy, if applicable, is attached. (See AFFIDAVIT below...)
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.

http://www.know-vaccines.org/exemptionFAQ.html

This AFFIDAVIT below is sufficient for a religious exemption statement from MMR and other vaccines to post secondary institutions. Please note that some of the universities may require the DH Form #681 in lieu of a statement.

AFFIDAVIT

Comes now, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being, state Citizen of the Florida Republic. Be it known to all courts, governments, and other parties that:

Being a person of Strong Christian Morals, it is against my Deep, Sincerely Held, Religious Convictions to accept the injection of any foreign substance into (my/our) (Body/Bodies) (or the Body of my Children). This includes, but is not limited to, any and all, Vaccinations, Shots, Tests for Diseases, Oral Vaccines, Epidermal Patches and in any other way that Live or Killed Bacterium, Viruses, Pathogens, Germs, or any other Microorganisms, may be introduced into or upon (my/our) (body/bodies) (or any of my children’s bodies).

This written statement to exempt (me/us) from any immunizations, Mantoux (PPD) Tuberculin (TB) Test, or other shots/injections, because I hold genuine and sincere personal religious beliefs which are inconsistent with these medical procedures & experimentation. The practice of vaccination and the injection of any foreign substance is contrary to my conscientiously held religious beliefs and practices, and violates the free exercise of my religious principles.

The Hepatitis-A vaccine containing MRC-5 is obtained from human babies that were electively aborted. WI-38 was created from the tissue of an aborted fetus and is used for the rubella portion of the MMR-II vaccine. RA 273 was created from the tissue of an aborted fetus, and is used for MMR-II vaccine. The Chickenpox (Varivax) vaccine contains MRC-5 and RA 273. A conflict arises because my religious convictions are predicated on the belief that all life is sacred. God's commandment "Thou Shall Not Kill" applies to the practice of abortion. The acceptance of these vaccines promote abortion and violates the Sixth Commandment of "Thou Shall Not Kill". The Hepatitis-B vaccine protects against a disease that is only transmitted through multiple sexual partners or street IV drug users. The acceptance of this vaccine promotes sexual promiscuity and immoral behavior in direct contradiction to the teachings of (my/our) faith.

(I/We), {First and Last name(s)}, (am/are) exercising (my/our) rights under the First Amendment of the US Constitution, the provisions afforded me to decline Hep B & meningitis vaccines pursuant to 1006.69 Section (2), to receive Religious Exemption from Vaccination & testing. Florida Administrative Code Chapter 6C-6.001 contains no rule or legislative reference which says that a claim for religious exemption must be documented on church letterhead, signed by clergy to to be exempted for the MMR or other vaccines. Therefore (I/We) (am/are) exercising (my/our) rights to receive Religious Exemption from MMR and/or any other 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.

The Lord Jesus Christ and Our Creator are the only source of protection of my body (and that of my family) that I can accept.

I affirm that vaccination & injections of any foreign substances and proteins conflict with my religious beliefs as stated above. Therefore, I would request that you accommodate my religious beliefs and practices by exempting (me/us) from any vaccination or injections of any kind.

Rest assured that my family and I do practice a form of immunization that keeps our immune systems strong and is in keeping with Biblical principles.

Further Affiant Saith Not

The use of notary below is for identification only, and such use does NOT grant any jurisdiction to anyone.

Subscribed and sworn, without prejudice, and with all rights reserved, (Print Name Below)


_______________________________________________________________,
Principal, by Special Appearance, in Propria Persona, proceeding Sui Juris.


_______________________________
Signature of Affiant


ACKNOWLEDGMENT

state of Florida

county of _________________:

On this _______ day of ______________, 200___, before me

personally appeared __________________________________, to me known to be the person described in and who executed the foregoing instrument and acknowledged that he executed the same as his free act and deed, for the purposes therein set forth.


_______________________________________
(Notary Public)

My Commission Expires ______________________________, 200___


An Adult Affidavit, with Christian beliefs, is here. (MSDOC file) Feel free to modify as needed.

Click for the desired information for your state

New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: Schools  |   DayCare  |   Preschool  |   K-12  |   College  |   (options) OptOutRegistry  |  
Adult Issues: Employment  |   TB_and/or_LeadTesting
Statues/Laws  |   Waivers_CareInSigning  |   Misc_Info, QXCI providers, Sponsors, etc.

OptOutRegistry for Vaccines
and various other Opt-Outs
Vaccine Registry Opt-Outs:

     - - - - Other Opt-Outs - - - -:

Birth Certificate and Marriage License Opt-Out:

Did you know that you can REFUSE to sign the hospital birth certificates and that there is no law that requires you to do so?
See: Marriage Licenses, Birth Certificates & #SSNs

Military Recruiters:

STUDENT OPT OUT FORM regarding the
RELEASE OF NAME, ADDRESS, AND TELEPHONE NUMBER TO MILITARY RECRUITERS
PDF-file (.pdf) http://www.militaryfreeschools.org/PDF/optout2.pdf

UNDERGROUND ACTION ALLIANCE STUDENT OPT OUT FORM
Word-Document (.doc) Archived on VacLib.org: http://veterans4peace.org/opt_out.doc

SAMPLE ENGLISH - BILINGUAL FORMS FOR OPTING OUT
Act to Protect Your Privacy from Military Recruiters
Information links and forms at AFSC site

STUDENT OPT-OUT - Google Search

STUDENT OPT-OUT NOTICE regarding the instruction of sexuality to children:
STUDENT OPT-OUT NOTICE Valid in all 50 states
PDF-file (.pdf) http://www.catholiccitizens.org/content/img/f26422/opt%20out%20notice.pdf

STUDENT OPT-OUT NOTICE - Google Search


Click for the desired information for your state

New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: Schools  |   DayCare  |   Preschool  |   K-12  |   College  |   (options) OptOutRegistry  |  
Adult Issues: Employment  |   TB_and/or_LeadTesting
Statues/Laws  |   Waivers_CareInSigning  |   Misc_Info, QXCI providers, Sponsors, etc.

Employment


A Hep B vaccine waiver for one employment service in Florida. American Traveler Staffing Professionals. Link to pdf form... http://www.americantraveler.net/pdf/app_hepatitis_b_waiver.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."
See TB Testing for more information.

US Fish and Wildlife Service Form 3-2283
Hepatitis B Immunization Consent/Refusal Form
PDF-file (.pdf) http://www.fws.gov/forms/3-2283.pdf

Click here for an Affidavit for Adult (college & employment religious exemption) ... Edit as needed...


Click for the desired information for your state

New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: Schools  |   DayCare  |   Preschool  |   K-12  |   College  |   (options) OptOutRegistry  |  
Adult Issues: Employment  |   TB_and/or_LeadTesting
Statues/Laws  |   Waivers_CareInSigning  |   Misc_Info, QXCI providers, Sponsors, etc.

TB and/or Lead Testing

TB-Links/Exemptions

Required for the University of Florida.

Generic letter for Exemption to TB Testing:
HTML (text): Exemption-tb-test.html

MS Doc file: Exemption-tb-test.doc

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."
TB and Lead Testing Links:
F L Y E R    LETTER    Exemption_Letters    OSHA_and_TB_test    Tubersol    Treatment    TB_Screening    Alternatives/Additional_Information

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.

See QXCI-BioMeridian Providers, etc below

Click for the desired information for your state

New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: Schools  |   DayCare  |   Preschool  |   K-12  |   College  |   (options) OptOutRegistry  |  
Adult Issues: Employment  |   TB_and/or_LeadTesting
Statues/Laws  |   Waivers_CareInSigning  |   Misc_Info, QXCI providers, Sponsors, etc.

Misc Info - QXCI providers - Sponsors - Etc.
Here are some of the practitioners for Florida

Florida BEST™ BioMeridian Practitioners:

Excelsior Health Clinic, Inc.
Meridian Stress Assessment
Heather L. Horne, LMT
MA-0024327
5217 W. Colonial Drive
Orlando, Florida 3280
Tel: 407-291-3303

Between Heaven & Earth
3601 W Commercial Blvd Suite 25
Ft Lauderdale, FL 33309
Located in Commerical Pointe
3 Blocks East of 441
(954) 667-6637
http://www.betweenheaven.com
ynge@betweenheaven.com
B.E.S.T ~ BIOMERIDIAN STRESS TEST

Longwood Preventive Medicine Group of Central Florida
212 West Bay Avenue, Longwood, Fl. 32750 (close to Orlando)
Phone: 407-265-1888
Fax: 407-265-9581
http://www.longwoodpreventive.com
LPMG uses the MSA (Meridian Stress Assessment) machine by Bio Meridian to test for imbalances in your body. It is a state of the art computerized system that measures electrical resistance at specific acupuncture points. These acupuncture points correspond to specific organs and tissues and give a general indication of the health of the organ tissue as a whole. The MSA device is FDA approved.

The Natural Solution, Inc.
Mistye Arnold - CNHC, MSAS, TFH, HTII, IIDA
Rockledge, FL 32955
Telephone: 321-632-8459
Fax: 321-632-1409
http://www.thenaturalsolution.biz
Email: mistye@apexenergetics.com
Or call Apex Energetics directly at 1-800-736-4381 pmt
Mistye’s education and training has been extensive for ten years and includes, Meridian Stress Assessment Systems (MSAS), Touch for Health, Healing Touch, Parasitology, Emotional Release Facilitation, Energetic Allergy Elimination Technique, Metabolic Profiling, Functional Endocrinology and Nutritional Counseling.

Fuller Chiropractic
501 N Orlando Ave Suite 151, Winter Park, FL 32789
Phone: 407-599-5555
Fax: 407-599-0692
http://www.fullerhealthcenter.com
info@fullerhealthcenter.com
Meridian Stress Assessment utilizing BioMeridian Computer Interface assessing dermal nerve points and nerve channels.

Better Body
3341 West Hillsboro Blvd
(NE Corner of Hillsboro and Powerline Rd)
Deerfield Beach, Florida 33442
Telephone: (954) 428-1500
http://www.betterbodyusa.com
E-mail: contact@betterbodyusa.com
Bio Meridian Stress Assessment . . . . . . . 60 minutes
This test is truly the most progressive computer generated analysis you can find for the information it provides. Includes a stress assessment of acupuncture points within the hands and the feet. This powerful modern computer technology can be compared to a polygraph, EKG and MRI test that measures electrical response on the surface of the skin. Results of the Bio-meridian stress test are incredibly insightful. Every organ and system in your body can be tested for imbalance. The results of the stress testing is remarkable and incredibly accurate.

Piro Clinic of Natural Medicine
Janice M. Piro, DC, DABCI
971-B Virginia Ave., Palm Harbor, Florida 34683
(727) 789-4020
Application For Treatment: http://www.piroclinic.com/pdf/newpatient.pdf
http://www.piroclinic.com
staff@piroclinic.com
With this appointment, the Meridian Stress Test is performed which defines the exact natural medicine protocol needed to unblock energy patterns that are inhibiting the attainment of health and that are causing the problems found with the diagnostic tests.

Florida QXCI Practitioners:

Body's Energy
Marie Cote, SCIO/EPFX Practitioner
Certified National Health Professional
Tampa, FL
813-805-2198
www.bodysenergy.com
bodysenergy@yahoo.com
Fees:
$130 - initial consultation, $75 per session thereafter

Premrup Streiker, M.S.W.; M. Ed.
EPFX / QXCI Practitioner, Counselor, Intuitive
Mediation, Emotional Depth Work, Energy Block release, Heightened Awareness, Chronic Physical Illness
Fees:
$150 Initial Session
$75 per hour after initial session
$1150 for 10 prepaid Sessions
Bonita Springs, Florida
Sun Valley, Idaho
Manhattan, Upstate New York
Brattleboro, Vermont
208-578-1265 (Idaho)
212-675-6529 (New York)
239-949-1746 (Florida)
208-720-6880 (cell)
premrup@mindspring.com
Web Address: www.quantumpremrup.com

For information on purchase or lease of the new Quantum Life BioFeedback L.I.F.E. System, please email Donna and leave your name, mailing address, phone number and email. If you're inquiring for another interested individual or practitioner, please leave their information. The company will then send information and contact the interested parties.
Or you may call 1-888-249-1421.


Immunization Registry Opt Out: Forms

Bureau of Immunization Florida SHOTS Notification and Opt Out Forms

http://www.flshots.org/forms/OptOutDH-1478.pdf

http://www.flshots.org/forms/DH1478Modified03_Spanish.pdf

These opt-outs are for the immunization registry only. They do not exempt you from vaccines.

You will still need to fill out and submit separate exemption forms, to be exempt from vaccines.

WHOLEFOOD
The Whole Food Farmacy.
FARMACY

Vaccine Information and Liberation
V.I.A.L. - Florida Chapter
Wendy Callahan, director
P.O. Box 1693
Hawthorne, Florida 32640
352-481-7024
Lovthatlea@aol.com
www.vaccinetruth.org
Vaccination Liberation - Idaho Chapter
"Free Your Mind....From The Vaccine Paradigm"
   www.VacLib.org/VaccineTruth.net
Vaccination Liberation Main Pages
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