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Alaska State Exemption Page
VacLib.org & VaccineTruth.net Exemption Page
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Statutes/Laws
StateLaw  |   Exemptions  |   PDF-Reader


Note: Be advised that websites and links change constantly. It would be wise to go through this page and save ALL the exemption forms and letters, in case a website goes down. Please share with others who also want to refrain from medical experimentation.

Link to state law.
National Vaccine Information Center:
http://www.nvic.org/Vaccine-Laws/state-vaccine-requirements/alaska.aspx


1) Statement by M.D., D.O., P.A, or advanced nurse practitioner OR
2) Affidavit affirming immunization conflicts with "tenets and practices of the church or religious denomination of which the applicant is a member"

For additional help with exemptions, birth plan,etc questions:
Non_Vaccinating_Physicians

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



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]


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

Birth Exemptions:

IMPORTANT! Please download this if you're expecting a child or know someone who is!

(.pdf) THE NORTHWEST REGIONAL NEWBORN SCREENING PROGRAM ALASKA PRACTITIONER’S MANUAL

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...

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) VaccineTruth.net/letters/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.


Vitamin K Injection...

The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert.
"WARNING - INTRAVENOUS USE Severe reactions, including fatalities, have occurred during and immediately after the parenteral administration of AquaMEPHYTON® (Phytonadione)."
fatalities=death
Links to prescribing information for Vitamin K:
http://vaclib.org/chapter/inserts.htm#vitK

Merck Vitamin K Package Insert - Aquamephyton PI | Scribd

The package insert should be printed out and used along with the birth plan letter, and your exemption letter or AFFIDAVIT. This shows the hospital or birthing center that you are aware of the risks of Vitamin K injection, and that they should be too.

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 safe alternative that your chiropractor or naturopath can order for you. Or order directly from Amazon.com

Biotics Research, Bio-K Mulsion - 1 fl oz

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.

Hepatitis B Vaccine Refusal from Dr. Sherri Tenpenny's webpage:
(.pdf) http://drtenpenny.com/wp-content/uploads/2012/06/Hep_B_in_the_hospital_1_.pdf
This form is generic. It can be used in other states.

See Birth Plans for more information on avoiding Hep B Vaccination at birth
Eyedrops
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
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/sites/genes-r-us/files/nbsdisorders.pdf

Newborn Genetic Screening Privacy Laws
(includes links to laws for various states)
Archived Copy: http://web.archive.org/web/20130603035608/http://www.ncsl.org/issues-research/health/newborn-genetic-and-metabolic-screening-laws.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


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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.

You may also use one or both of these to give to your doctor:
(.doc) http://www.vaclib.org/letters/Letter-to-doctor.doc
(.pdf) Vaccine Refusal & Exemption Forms
http://drtenpenny.com/forms/

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 From developed by The American Academy of Pediatrics, not a regular religious or conscientious exemption letter or form.


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

Link to Refusal to Permit Medical Treatment form

Links to Affidavit - Birth


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

Vaccine Refusal & Exemption Forms
http://drtenpenny.com/forms/

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

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

Did not find your state exemption form on our site?
Then try this link to forms for all 50 states and D. of Columbia.
http://experimentalvaccines.org/vaccine-exemption-forms/


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


State Form Required: No

Daycare & Preschools
Archived:
(.pdf) http://www.kpbsd.k12.ak.us/healthservices/forms/I_103_im_Exem..pdf

Alaska School and Child Care Immunization Manual
Medical Exemption Form on page 51
Religous Exemption Form on page 52
(.pdf) http://www.epi.hss.state.ak.us/pubs/manualaugust.pdf

Kindergarten & Schools
Archived:
(.pdf) http://www.kpbsd.k12.ak.us/healthservices/forms/I_103_im_Exem..pdf

Alaska School and Child Care Immunization Manual
Medical Exemption Form on page 51
Religous Exemption Form on page 52
(.pdf) http://www.epi.hss.state.ak.us/pubs/manualaugust.pdf

Fairbanks North Star Borough School District
(This is a whole forms manual for the school nurse, but the immunization exemption forms are in it)
School Medical Exemption Form is on page 31
School Religious Exemption Form is on page 104
(.pdf) Archive: http://webserver.northstar.k12.ak.us/health/nursesServiceForms2003.pdf
(.pdf) Archive: http://www.northstar.k12.ak.us/health/nursesServiceForms2003.pdf

Juneau School District
ALASKA IMMUNIZATION REQUIREMENTS:
RELIGIOUS EXEMPTION FORM

(.pdf) http://www.juneauschools.org/uploads/0/parents/health-forms-and-information/ak-immunization-requirements-religious-exemption-form.pdf

Department of Health & Social Services
2009 – 2010 School Year
ALASKA CHILD CARE & SCHOOL IMMUNIZATION REQUIREMENTS Packet
Revised 11/23/09
Medical Exemption Page 13
Religious Exemption Form Page 14
(.pdf) http://www.epi.hss.state.ak.us/id/iz/factsheet/IZReqPacket2010.pdf

New state-required medical exemption / history of disease form

[PDF] ALASKA IMMUNIZATION REQUIREMENTS
Department of Health & Social Services

(.pdf) http://www.epi.hss.state.ak.us/id/iz/MedicalExemption.pdf

Medical Exemption Form
(.pdf) http://dhss.alaska.gov/dph/VaccinateAlaska/Documents/VACFACT_IZchanges.pdf

Copper River School District
Medical Exemption Form Page 5
2009 – 2010 School Year
ALASKA CHILD CARE & SCHOOL
IMMUNIZATION REQUIREMENT CHANGES

(.pdf) http://www.crsd.k12.ak.us/health/ImRequirements.pdf

A good Summary of the concept that one is not required to hold formal church membership can be found at: http://www.alaskawellness.com/archives/school-vacc.htm.

Colleges/Universities

Alaska - University of Alaska Anchorage Hep B waiver
(.pdf) http://ehsrms.uaa.alaska.edu/VaccinationWaiverFormApp12.pdf.


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

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Employment
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 below 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

Employment:

May use the AFFIDAVIT for Alaska Adult (above) and edit as needed.

Fairbanks North Star Borough School District
It's from this page
Hepatitis B Vaccine Declination Waiver
(.pdf) ‘Bloodborne Pathogens Exposure Control Plan/Handbook’
       This is the exposure control plan regarding Blood-borne pathogens.

Fairbanks North Star Borough School District
Hepatitis B Vaccine Declination Waiver Only (District Employees)
Archived: Old Form!
(.pdf) http://www.northstar.k12.ak.us/hr/forms/decline-HepB.pdf

STATE OF ALASKA Department of Corrections
Hepatitis B Vaccine Declination Form 202.03C (Employees)
(.pdf) http://www.correct.state.ak.us/corrections/pnp/pdf/202.03c.pdf

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TB and/or Lead Testing

TB-Links/Exemptions

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/QuantiFERON_TB_Gold_testimony

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 Test:

Required. No religious exemptions for TB test. 7 AAC 27.213

Alaska State law requires PPD (purified protein derivative) tuberculin skin testing for all students in kindergarten, 7th grade and new to our school district. Students previously enrolled in the Anchorage School District, who are returning from another district, are not considered new to the district. The Alaska Department of Health and Social requires a Mantoux PPD, an intradermal injection for the skin test. Some vocational programs also require a PPD skin test.

Exemption from PPD testing is permitted if you provide results from a PPD skin test given six months prior to school entry, or a physician states that skin testing would be injurious to your child’s health. If your child had a previous positive PPD test with a reading of 10 mm or more, a skin test is not required. A BCG vaccination is not an exemption from tuberculin testing, and there is no exemption from tuberculin skin testing for religious belief or personal objection.

For vaccination and TB tine testing/Mantoux exemption information and support:

Hoss LeFevere
Egegik, Alaska 99579
(907) 233-2238
anglovangelist@yahoo.com


TB Testing Alternatives...

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.

Here are some of the practitioners for Alaska

Alaska BEST™ BioMeridian Practitioners:

Please call contact below to find BioMeridian practitioners in your area or closeby.

Oksana Gorodetsky
Marketing/Administrative Coordinator
BioMeridian International
12411 South 265 West, Suite F
Draper, UT 84020
T 801-501-7517
F 801-501-7518
Toll Free 888-224-2337
ogorodetsky@biomeridian.com

Alaska QXCI Practitioners:

http://www.theqxci.com/information.php

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 1-407-672-6144.
The L.I.F.E. System is also registered with the FDA for safety issues as a Class 2 Biofeedback Device

The Whole Food Farmacy.


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

KNOW YOUR RIGHTS
Confidentiality of Your Child’s Vaccination Records
FERPA: The Family Educational Rights and Privacy Act
http://www.vaxchoicevt.com

     - - - - 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) Archived letter from www.militaryfreeschools.org

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


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Misc Info - Sponsors - Etc.