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

Link to state law.
National Vaccine Information Center:
Link to state law.


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  &  Philosophical


Immunization requirements "shall not apply if the parents or legal guardian of that child object thereto on the grounds that immunization conflicts with the religious or philosophical beliefs of the parent or guardian." To obtain an exemption parents must sign a notarized statement requesting a religious, medical or philosophical exemption from the Department of Health (DOH). The parents must then complete an educational component prepared by the DOH, sign an informed consent with a refusal to vaccinate statement and a signed statement of understanding that the unimmunized child may be removed from school during an outbreak. This is a new law signed on April 1, 2003, the forms and education may still be in development but the law is enacted. For pertussis: if a child's sibling or half sibling had an adverse reaction the child is exempt.
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:

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.
Affidavit - Birth Exemptions
HTML (simple text) Affidavit to modify.
AFFIDAVIT in Microsoft Word Word-Document (.doc) format. (may be modified)

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.
"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

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. 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.

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
Arkansas specifics

Religious Exemption from newborn screening allowed. Ark. Stat. Ann. § 20-15-303

20-15-303. Exception.
The provisions of this subchapter shall not apply to any child whose parents or guardian objects thereto on the grounds that it conflicts with the tenets and practices of a recognized church or religious faith of which the parent or guardian is an adherent or member.
History. Acts 1967, No. 192, § 3; A.S.A. 1947, § 82-627.

http://law.justia.com/codes/arkansas/2010/title-20/subtitle-2/chapter-15/subchapter-3/20-15-303/

Hearing Screening...

ARKANSAS

Statute: Sec.5. No test is be performed if the parent of a newborn/infant dissents on the ground that the test conflicts with personal religious belief or practice. [Source: SB 819, 1999]

Rule: Sec.V. No test to be performed if the parent of a newborn/infant dissents on the ground that the test conflicts with personal religious belief pr practice. [Source: Arkansas Code Annotated 20-15-1501, 1999]


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.

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

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

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: Yes.
  To obtain an exemption, parents must sign a notarized statement:
- Requesting a religious, medical or philosophical exemption from the Department of Health (DOH).
- The parents must then complete an educational component prepared by the DOH,
- sign an informed consent with a refusal to vaccinate statement
- and a signed statement of understanding that the unimmunized child may be removed from school during an outbreak.

Note: Do not sign the state provided form. See Waiver - Care in signing

Arkansas Exemption Application (Scanned Green Form for 2005-2006) only
(.pdf) VaccineTruth.net/letters/Dear Parent/Guardian or College/University Student

Scanned Green Form 2005-2006 for viewing only. Do not use this one!
(.pdf) VaccineTruth.net/letters/Refusal To Vaccinate and Statement of Understanding

WARNING!!   Do not use the above Refusal To Vaccinate scanned form!!  There is deliberate trickery in the language of the above form that can legally be used against you.

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 Dr. Faye Boozman, Director of the Arkansas Department of Health.

If you need assistance, the staff of the "American Family Voice" newspaper will provide that assistance. You may call the Voice at 479-880-2026 or email us at theafvoice@cox-internet.com. AFV reports on alternative/complementary healthcare as well as the truth that major media ignores. AFV staffers are members and officers of the Arkansas Health Freedom Coalition.

DayCare & Preschools

Arkansas Exemption Application (Scanned Green Form for 2005-2006) only
(.pdf) VaccineTruth.net/letters/Dear Parent/Guardian or College/University Student

Use these Modified Refusal To Vaccinate Forms below. The language trickery has been edited out to keep you legally safe. Print out on pastel green paper for 2005-2006 school year.

(.doc) VaccineTruth.net/letters/Modified Refusal To Vaccinate and Statement of Understanding

(.pdf) VaccineTruth.net/letters/Modified Refusal To Vaccinate and Statement of Understanding

The letters and affidavits below are not state approved for applying for exemption. These are optional, and useful in case you are asked for further explanation when requesting state exemption form.

(.doc) VaccineTruth.net/letters/Arkansas Exemption letter (applying for state issued exemption).doc

(.doc) VaccineTruth.net/letters/AFFIDAVIT for Arkansas Older Child.doc


While these letters are not approved and required by the state; they can still be helpful in obtaining the state issued Certificate of Exemption. The state issued form is required.

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 Dr. Faye Boozman, Director of the Arkansas Department of Health.

If you need assistance, the staff of the "American Family Voice" newspaper will provide that assistance. You may call the Voice at 479-880-2026 or email us at theafvoice@cox-internet.com. AFV reports on alternative/complementary healthcare as well as the truth that major media ignores. AFV staffers are members and officers of the Arkansas Health Freedom Coalition.


Kindergarten & Schools
Arkansas Exemption Application (Scanned Green Form for 2005-2006) only
(.pdf) VaccineTruth.net/letters/Dear Parent/Guardian or College/University Student

Use these Modified Refusal To Vaccinate Forms below. The language trickery has been edited out to keep you legally safe. Print out on pastel green paper for 2005-2006 school year.

(.doc) VaccineTruth.net/letters/Modified Refusal To Vaccinate and Statement of Understanding

(.pdf) VaccineTruth.net/letters/Modified Refusal To Vaccinate and Statement of Understanding

The letters and affidavits below are not state approved for applying for exemption. These are optional, and useful in case you are asked for further explanation when requesting state exemption form.

(.doc) VaccineTruth.net/letters/Arkansas Exemption letter (applying for state issued exemption).doc

(.doc) VaccineTruth.net/letters/AFFIDAVIT for Arkansas Older Child.doc

While our letters above are not approved and required by the state; they can still be helpful in obtaining the state issued Certificate of Exemption. The state issued form is required.


Colleges/Universities

Most colleges are requiring the state issued exemption form same as preschools and schools. The same procedures apply.


University of Central Arkansas
Persons seeking religious exemption should fill out section B on the back of this form University of Central Arkansas Certificate of Immunization
(Religious Exemption on last page)
(.pdf) http://www.uca.edu/divisions/international/pdf/certofimmunization.pdf

If your college or university requires you to submit your own letter, some colleges may have their own versions that can sometimes be found online.
The Affidavits below may be useful for your use:
Note:
Most colleges have their own meningitis and Hepatitis B vaccine waiver forms which are required. You would use the waivers in addition to this AFFIDAVIT, since other vaccines, specifically MMR and sometimes tetanus, are required.
(.doc) VaccineTruth.net/letters/AFFIDAVIT for Arkansas Adult.doc
(.wpd) VaccineTruth.net/letters/AFFIDAVIT for Arkansas Adult.wpd

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

If you need an Affadivit for employer, see the letters above.

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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 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 Arkansas

Arkansas 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

Arkansas QXCI Practitioners:

http://www.qxciscio.com/qxci-arkansas-ar.html

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.


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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.

Arkansas Health Freedom Coalition

ARHFC

PO Box 733

Waldron, Arkansas 72958

Presidents Phone:   479-637-4361

Email Address: arhfc@lycos.com



The Whole Food Farmacy.