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California State Exemption Page
VacLib.org & VaccineTruth.net Exemption Page
Main Sections of this web page
New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits

School-Daycare-Preschool Issues: statutes/Laws  |   DayCare_Schools_Colleges  |   Letters_Forms_Affidavits  |   (options) OptOutRegistry

Adult Issues: Employment  |   TB_and/or_LeadTesting  |   (options) OptOutRegistry

Misc_Info, Sponsors, etc.

statutes/Laws
StateLaw  |   Exemptions  |   PDF-Reader

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


Alert: California Vaccine Exemptions
California AB2109 has been signed into law and takes effect January 1, 2014.
At that time, parents must pay for a Dr. Appointment to TRY to Obtain a Personal Belief Exemption
Language of the changed law:
http://www.leginfo.ca.gov/pub/11-12/bill/asm/ab_2101-2150/ab_2109_bill_20120831_enrolled.pdf


Additional note: California Governor Edmund Brown has directed the Health Department to implement a separate Religious Exemption that will not require a health care signature. Time will tell if this "direction" will be honored.

Calif Code snips    |    Summary/List of commonly used links

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  &  Personal Beliefs Exemption (PBE)
  Note: In California, the religious, philosophical and "other" belief exemptions are all under the umbrella term: "Personal Beliefs Exemption" (PBE).


Important:
July 1, 2011 a new Tdap booster vaccine is required to enter California schools, grades 7-12. Both the medical and Personal Beliefs Exemption (PBE) are available. Schools have been given a new form, CDPH 8261 to be used for the Tdap booster. Click here for our FAQ on CDPH 8261.


CA law snips - Quicklinks
EDUCATIONAL AND CHILD CARE FACILITY IMMUNIZATION REQUIREMENTS ... 120325-120380
120325.
   (c) Exemptions from immunization for medical reasons or because of personal beliefs.

TUBERCULOSIS TESTS FOR PUPILS ... 121475-121520
HEALTH AND SAFETY CODE SECTION 121475
   (c) Exemptions from tuberculosis tests because of personal beliefs.

HEALTH AND SAFETY CODE SECTION 121505. The certificate shall not be required for a person who is subject to an order made pursuant to subdivision (a) of Section 121485, if the parent, guardian, or other adult who has assumed responsibility for his or her care and custody in case of a minor, or the person seeking admission, if an emancipated minor, provides to the governing authority an affidavit stating that the examination required to obtain the certificate is contrary to his or her beliefs. If at any time there should be probable cause to believe that the person is afflicted with active tuberculosis, he or she may be excluded from the school or other institution listed in Section 121485 until the governing board is satisfied that he or she is not so afflicted.

Article 6.5. Newborn and Infant Hearing Screening, Tracking, and Intervention Program .... 124115-124120.5
124116.5.
   (d) This section shall not apply to any newborn whose parent or guardian objects to the test on the grounds that the test is in violation of his or her beliefs.

Newborn Eye Pathology Screening .... 124111-124112
HEALTH AND SAFETY CODE SECTION
124112.
   (d) Any screening examination recommended pursuant to subdivision (a) shall not be conducted on a newborn if a parent or guardian of the newborn objects to the examination on the grounds that the examination conflicts with the religious beliefs or practices of the parent or guardian.

Newborn Screening ... 125000-125002
[phenylketonuria and other preventable heritable or congenital disorders]
125000.
   (d) This section shall not apply if a parent or guardian of the newborn child objects to a test on the ground that the test conflicts with his or her religious beliefs or practices.

Prenatal Testing ... 125050-125119.5
125110. The Maternal and Child Health Program Act (Section 27) shall not apply if the pregnant woman objects to the test required by that act on the ground that the test conflicts with her religious beliefs or practices.
Summary of commonly used forms
and links to State Regulations.
Note: for details of each section Click Here.

Handbook of Daycare Vaccination Requirements:
http://www.dss.cahwnet.gov/getinfo/pdf/ccc5.PDF


Daycare Exemption Info:
http://www.dss.cahwnet.gov/getinfo/pdf/ccc5.PDF
on page 115 of document.

Exemption form Link, childcare and K-12:
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/pm286b.pdf


School Vaccination Requirements K-12:
http://www.cdph.ca.gov/programs/immunize/Documents/IMM-365D.pdf


Higher Ed Vaccination Requirements:
http://www.cdph.ca.gov/programs/immunize/Documents/IMM-1014.pdf


Higher Ed Exemption Info:
California does not have a state exemption form for college students. Ask the college for an exemption form. If they do not have one write a letter or affidavit stating the vaccine is against your beliefs. See page D-76 of
http://www.cdph.ca.gov/programs/immunize/Documents/IMM-365D.pdf
[The link at the top of this paragraph]
A few colleges have their forms online, Click here.

State Dept of Health Link
(Vaccination Program including exemption information):
http://www.cdph.ca.gov/programs/immunize/Pages/Default.aspx


Following paragraphs are a
BREIF Description of Recent Law Changes and any state health department or legislative links that would be helpful to document:

Information on new Tdap booster shot requirement for 7th through 12th grade students. Exemptions permitted for verified medical conditions or personal beliefs.
http://www.cdph.ca.gov/programs/immunize/Documents/EarlyAlertToSchools-AB354.pdf

More info is in our VacLib FAQ on Tdap CDPH8261 form, found here.

AB499 was passed and signed by Governor Brown. The new law allows minors 12 years old and older to consent to vaccines for sexually transmitted diseases without the knowledge or consent of their parents. This includes HPV Vaccine and any vaccines approved in the future.
http://www.leginfo.ca.gov/pub/11-12/bill/asm/ab_0451-0500/ab_499_bill_20111009_chaptered.html

SECTION 1. Section 6926 of the Family Code is amended to read:
6926. (b) A minor who is 12 years of age or older may consent to medicalcare related to the prevention of a sexually transmitted disease.
State Immunization Tracking System info:
http://cairweb.org/


Immunization Tracking System opt out info:
Patient and Parent Rights
http://cairweb.org/images/docs/SIISDisclosureform_MedicalOfficeHandout_REV62111.pdf

It's your legal right to ask:
  • Not to share your (or your child's) registry shot records with others besides your doctor.

  • Not to get shot appointment reminders from your doctor's office.

  • To look at a copy of your or your child's shot records, who has seen the records or to have the doctor change any mistakes.

Form to decline having your child’s immunization information shared:
http://cairweb.org/images/docs/CAIRDeclineFormNewFax.pdf



PDF documents (.pdf)

A PDF reader is required for PDF Files:
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Or Free Download of Acrobat Reader: [Adobe. 43 MB file size]


statutes/Laws
New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: statutes/Laws  |   DayCare_Schools_Colleges  |   Letters_Forms_Affidavits  |   (options) OptOutRegistry
Adult Issues: Employment  |   TB_and/or_LeadTesting  |   (options) OptOutRegistry
Misc_Info, 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.

Religious Exemption from newborn screening allowed. Cal. Health & Safety Code § 125000

Cal. Health & Safety Code § 125000(d)
(d) This section shall not apply if a parent or guardian of the newborn child objects to a test on the ground that the test conflicts with his or her religious beliefs or practices.


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
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
Modify as necessary:

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.
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. 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.

California Specific
VITAMIN K ADMINISTRATION: Every neonate should receive a single parenteral 0.5-1.0 mg dose of vitamin K oxide or phytonadione (AquaMEPHYTON®) within 1 hour of birth for prevention of vitamin K deficiency bleeding (Hemorrhagic Disease of the Newborn). Occasionally parents will refuse vitamin K or request oral administration.
If parents persist in their refusal, they must sign the "Refusal to Permit Medical Treatment" form. These forms are kept in the file cabinet behind the unit clerk's desk in the WBN.

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



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

General Information

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


California Specific Newborn Screening
Notice of Information and Privacy Practices (CDPH)
http://www.cdph.ca.gov/HealthInfo/Documents/NPP Newborn Screening English.pdf

Newborn Screening Practitioner's Manual

The California Newborn Screening Program
To order any of these forms, please call (510) 540-3302.
Newborn Screening Test Refusal (NBS-TR): English or Spanish
Completed and signed by parent(s) who are refusing for religious reasons to have a newborn screening specimen collected on their child.


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

UCSF Children's Hospital
Intensive Care Nursery House Staff Manual
(.pdf) http://www.ucsfhealth.org/childrens/health_professionals/manuals/24_WellBabyNursery.pdf
from UCSF Medical Center
Some excerpts...

California Specific Information
EYE PROPHYLAXIS against gonococcal opthalmia neonatorum is mandatory for all neonates. A 1-2cm ribbon of sterile ophthalmic ointment containing 0.5% erythromycin should be administered within 1 hour of birth. Although California state law mandates neonatal eye prophylaxis, parents who refuse may sign a special waiver. This form is entitled "Refusal to Allow Treatment of Eyes of Infant with Prophylactic-Efficient Agent" and is located in the cabinet behind the unit clerk's desk in the WBN.

statutes/Laws
New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: statutes/Laws  |   DayCare_Schools_Colleges  |   Letters_Forms_Affidavits  |   (options) OptOutRegistry
Adult Issues: Employment  |   TB_and/or_LeadTesting  |   (options) OptOutRegistry
Misc_Info, Sponsors, etc.

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.


statutes/Laws
New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: statutes/Laws  |   DayCare_Schools_Colleges  |   Letters_Forms_Affidavits  |   (options) OptOutRegistry
Adult Issues: Employment  |   TB_and/or_LeadTesting  |   (options) OptOutRegistry
Misc_Info, Sponsors, etc.

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

Link to Refusal to Permit Medical Treatment form

Links to Affidavit - Birth

Commonly used links to California:
Daycare Vaccination Requirements, Daycare Exemption Info, K-12 Immunization Requirements, Exemption Form PM286B, College Immunization Requirements, DOH link, Recent Law Changes and Tracking Registry Opt-out info. Here.

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/


statutes/Laws
New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: statutes/Laws  |   DayCare_Schools_Colleges  |   Letters_Forms_Affidavits  |   (options) OptOutRegistry
Adult Issues: Employment  |   TB_and/or_LeadTesting  |   (options) OptOutRegistry
Misc_Info, Sponsors, etc.

DayCare - Schools - Colleges
DayCare-K-12-Colleges

(.pdf)
Vaccine & TB test exemption is in Spanish on back of form.
PM 286 B (1/02) California School Immunization Record (fill-in)

Alternate Link:
http://www.cdph.ca.gov/programs/immunize/Documents/pm286b.pdf


State Form Required: "No."
However,while CA statute law does not require a specific form there is a relatively new form for grades 7-12 (Pertussis) that CDPH says is required:
http://vaclib.org/exempt/states/ca/FAQ-CDPH8261.htm

Commonly used links to:
Daycare Vaccination Requirements, Daycare Exemption Info, K-12 Immunization Requirements, Exemption Form PM286B, College Immunization Requirements, DOH link, Recent Law Changes and Tracking Registry Opt-out info. Here.



DayCare & Preschools  |   1 thru 12  |   Colleges
DayCare & Preschools
(.pdf)
Vaccine & TB test exemption is in Spanish on back of form.
PM 286 B (1/02) California School Immunization Record (fill-in)

Alternate Link:
http://www.cdph.ca.gov/programs/immunize/Documents/pm286b.pdf

(.pdf) California Generic Exemption for all schools

Commonly used links to:
Daycare Vaccination Requirements, Daycare Exemption Info, K-12 Immunization Requirements, Exemption Form PM286B, College Immunization Requirements, DOH link, Recent Law Changes and Tracking Registry Opt-out info. Here.

Rosamond Bible Preschool
Exemption from Immunization form [Archived]
(.doc) http://www.rbpsol.com/Forms/Immunization.doc

Waiver of health examination. Page 1 is English, Page 2 is Spanish.
(.pdf) http://www.dhcs.ca.gov/formsandpubs/forms/Forms/ChildMedSvcForms/pm171b(bi).pdf.

Another source for the Health Examination waiver form
(.pdf) http://www.ieminc.org/Enrollment/Health%20Waiver.pdf

AFFIDAVIT for California Older Child (for daycare, preschool or school) below...

Note: In California, vaccine exemptions come under the broad term, "Personal Beliefs Exemption" (PBE) and thus a wide range of beliefs are protected. Our affidavits may be modified to reflect beliefs other than what we provide as an example. Calif Code snips


AFFIDAVIT

I/We, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being(s), state Citizen(s) of the California Republic affirm: Be it known to all courts, governments, and other parties that:

Being (a person/people) of Strong Christian Morals, it is against (my/our) Deep, Sincerely Held, Religious Convictions to accept the injection of any foreign substance into (my Body/our Bodies) or the Body of (my/our) (Child/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 body or any of my children's bodies.

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

The attenuated virus used to produce the Rubella vaccine (RA27/3) was obtained from an aborted fetus and then cultivated on fetal tissue from another aborted baby (WI-38) and is also in the rubella portion of the MMR-II vaccine. The Chickenpox vaccine containing WI-38, MRC-5 and Hepatitis-A vaccine (MRC-5) were obtained from human babies that were electively aborted. A conflict arises because (my/our) 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 promotes abortion and violates the Sixth Commandment of "Thou Shall Not Kill". The Hepatitis-B vaccine supposedly protects against a disease that is only transmitted through multiple sexual partners or street IV drug users and therefore usurps (my/our) parental authority to condemn such activity in (my/our) child. The acceptance of this vaccine promotes sexual promiscuity and immoral behavior in direct contradiction to the teachings of (my/our) faith.

(We / I) {First and Last name(s)}, as the {(parent (s) / guardian(s)}of _________________________(name of child) are/am exercising our rights under the First Amendment of the US Constitution, California Health & Safety Code #120365, and California Health and Safety Code 121475 (b) to receive Religious Exemption from Vaccination and (TB Testing).

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.

Our Creator Yahweh is the only source of protection of my body and that of my family that I can accept.

(I/We) affirm that vaccination & injections of any foreign substances and proteins conflict with (my/our) religious beliefs as stated above. Therefore, (I/we) would request that you accommodate (my/our) religious beliefs and practices by exempting (my/our) child from any vaccinations, injections and testing 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 California

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___


Schools

Commonly used links to:
Daycare Vaccination Requirements, Daycare Exemption Info, K-12 Immunization Requirements, Exemption Form PM286B, College Immunization Requirements, DOH link, Recent Law Changes and Tracking Registry Opt-out info. Here.

Important:
July 1, 2011 a new Tdap booster vaccine is required to enter California schools, grades 7-12. Both the medical and Personal Beliefs Exemption (PBE) are available. Schools have been given a new form, CDPH 8261 to be used for the Tdap booster. Click here for our FAQ on CDPH 8261.


Links to CA state vaccine exemption form may be found above, Click here for PM 286 B.

Sample Letter for School Vaccination Waiver
Download: (.doc) California School Vaccination Waiver

Sample Letter for School Vaccination Waiver WWW.churchstate.org

Date



School or Governing Authority

Address

City, State, Zip Code



RE: Vaccination Exemption for (Child's Name)



Dear (Name):



As (parent or guardian) of (name of child) I am writing to request an exemption from the (school district or educational institution) immunization requirements. This is based upon my philosophical objections to the practice of immunization. I am claiming this exemption for (name of child) in accordance with California Health and Safety Code Section 120365, which reads as follows:


Immunization of a person shall not be required for admission to a school or other institution listed in Section 120335 if the parent or guardian or adult who has assumed responsibility for his or her care and custody in the case of a minor, or the person seeking admission if an emancipated minor, files with the governing authority a letter or affidavit stating that the immunization is contrary to his or her beliefs.


This letter serves as my formal request to (school district or educational institution) that the required immunizations for (child's name) be waived because this medical practice is contrary to my beliefs. Thank you for your attention to this important matter. If you have any questions do not hesitate to contact me.



Sincerely,




Your Name



Enclosure: (YOUR STATE) Health and Safety Code



Xc: Michael Peabody, Esq., Vice President

Seventh-day Adventist Church State Council

(For TB exemptions, you may use the CA state form PM 286 B below:)
and/or modify one of the letters below in the TB section)
(.pdf)
Vaccine & TB test exemption is in Spanish on back of form.
PM 286 B (1/02) California School Immunization Record (fill-in)

Alternate Link:
http://www.cdph.ca.gov/programs/immunize/Documents/pm286b.pdf


Commonly used links to:
Daycare Vaccination Requirements, Daycare Exemption Info, K-12 Immunization Requirements, Exemption Form PM286B, College Immunization Requirements, DOH link, Recent Law Changes and Tracking Registry Opt-out info. Here.

VALLEY CHRISTIAN ELEMENTARY SCHOOL
HEALTH EXAM FORM
IMMUNIZATION EXEMPTION FOR PERSONAL BELIEFS:
Bottom of page 1, sign and date.
(.pdf) http://www.dublinvcc.org/schools/elmentary/forms/health_form.pdf

Waiver of health examination. Page 1 is English, Page 2 is Spanish.
(.pdf) http://www.dhcs.ca.gov/formsandpubs/forms/Forms/ChildMedSvcForms/pm171b(bi).pdf.

Another source for the Health Examination waiver form
(.pdf) http://www.ieminc.org/Enrollment/Health%20Waiver.pdf


SELF-REALIZATION FELLOWSHIP Youth Program
3880 San Rafael Avenue, Dept. 9W
Los Angeles, CA 90065-3298
'Our child is exempt from the immunization requirement based on an affidavit we signed stating that immunization is contrary to our beliefs. We understand and agree that in case of an outbreak of any one of the diseases for which immunization is required, our child may be temporarily excluded from attending the Youth Program for his/her protection and for the protection of others.'
__________________________      __________________________
Parent/Guardian Signature                     Date

2nd page on the health form
(.pdf) Youth-Program-Application.pdf


SAMPLE EXEMPTION LETTER

Date
School/ Institution
1776 Independence Way
Anytown, CA

To Whom it May Concern,

This letter is to serve as an affidavit, stating that vaccinations are contrary to what I believe is healthy for my child, Child's Name.

Health & Safety Code #120365. states that, it is my legal right to decline such vaccinations for my child.

Thank you kindly,

Legal Parent / Guardian

" Some schools my have their own exemption form, or may use a form provided by the county health dept. However, a straightforward personal communication is better assurance that your rights will be respected.
" The California philosophical belief exemption (health & safety Code #120365.) is your legal right as a parent, to enroll your child in public school without vaccinations.
" The right also applies to legal adults seeking admission to a community college.
" Under the law school authorities can not deny this right. However, they may be unaware of the legal exemption and know only to follow general procedure.
" Private schools are sometimes a challenge and may have their own policies.
" Terrorizing parents with threats of disease to their child for non vaccine compliance is a common practice.
" The media, health agencies and doctors, etc., who proclaim that children (and or college students) can not be admitted to school without hepatitis-B and other vaccines are simply parroting false information.
" Something is very wrong when people are told they do not have rights that they do in fact have.
" The bottom line is; money is made each time any body is vaccinated and "free vaccinations" are not free. They have simply been paid for in advance with your tax dollars.

Note: This information does not constitute legal or medical advice.

Colleges/Universities

Higher Ed Vaccination Requirements:
http://www.cdph.ca.gov/programs/immunize/Documents/IMM-1014.pdf


Higher Ed Exemption Info:
California does not have a state exemption form for college students. Ask the college for an exemption form. [A few links to college forms are below.] If they do not have one write a letter or affidavit stating the vaccine is against your beliefs. See page D-76 of
http://www.cdph.ca.gov/programs/immunize/Documents/IMM-365D.pdf
[The link at the top of this paragraph]

ONLINE FORMS:

CA State Fullerton University Hep B and MMR vaccine waiver form
(.pdf) http://www.fullerton.edu/shcc/pdfs/Waiver_Form.pdf

University of Southern California
(OLD/Archived) HEPATITIS B VACCINATION DECLINATION FORM (University Students)
(.pdf) (OLD/Archived) HEPATITIS B VACCINATION DECLINATION FORM
http://web.archive.org/web/20050130074431/studenthealth.ucsd.edu/pdfdocs/hepbreqstatement.pdf

Humboldt State University
Student Health Center
Arcata, CA 9552
Immunization Form
Exemption request bottom of page 2.
(.pdf) http://www.humboldt.edu/forms/sites/forms/files/Immunization%20Requirements%202013_0.pdf

AFFIDAVIT for California Adult (college religious exemption) ... Edit as needed...
You may use this for employment situtations as well.

Note: In California, vaccine exemptions come under the broad term, "Personal Beliefs Exemption" (PBE) and thus a wide range of beliefs are protected. Our affidavits may be modified to reflect beliefs other than what we provide as an example. Calif Code snips
AFFIDAVIT

I, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being, state Citizen of the California Republic affirm: 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 Body. 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 body.

This written statement to exempt myself from the immunization requirement, and the Mantoux (PPD) Tuberculin Test, because I hold genuine and sincere personal religious beliefs which are inconsistent with these medical procedures and 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 attenuated virus used to produce the Rubella vaccine (RA27/3) was obtained from an aborted fetus and then cultivated on fetal tissue from another aborted baby (WI-38), and is also in the rubella portion of the MMR-II vaccine. The Chickenpox vaccine containing WI-38, MRC-5 and Hepatitis-A vaccine (MRC-5) were obtained from human babies that were electively aborted. 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 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.

I, {First and Last name}, am exercising my rights under the First Amendment of the US Constitution, California Health & Safety Code #120365, and California Health and Safety Code 121475 (b) to receive Religious Exemption from Vaccination & (TB) testing.

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.

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 foreign proteins conflict with my religious belief as stated above. Therefore, I would request that you accommodate my religious beliefs and practices by exempting me from the college vaccination and TB testing requirement.

Rest assured that I do practice a form of immunization that keeps my immune system 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 California

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.

statutes/Laws
New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: statutes/Laws  |   DayCare_Schools_Colleges  |   Letters_Forms_Affidavits  |   (options) OptOutRegistry
Adult Issues: Employment  |   TB_and/or_LeadTesting  |   (options) OptOutRegistry
Misc_Info, Sponsors, etc.

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


California Specific Employment:

Note: Hospital Health Care Workers in California may opt out of yearly influenza shots.
California Health Care Workers
Source: http://www.cdph.ca.gov/programs/immunize/Pages/CaliforniaHospitalInfluenzaLaw.aspx

California Hospital Influenza Law

With the chaptering of SB 739, the California Health and Safety Code will read effective January 1, 2007.

1288.7. By July 1, 2007, the department shall require that each general acute care hospital, in accordance with the Centers for Disease Control guidelines, take all of the following actions:
(a) Annually offer onsite influenza vaccinations, if available, to all hospital employees at no cost to the employee. Each general acute care hospital shall require its employees to be vaccinated, or if the employee elects not to be vaccinated, to declare in writing that he or she has declined the vaccination.
(b) Institute respiratory hygiene and cough etiquette protocols, develop and implement procedures for the isolation of patients with influenza, and adopt a seasonal influenza plan.
(c) Revise an existing or develop a new disaster plan that includes a pandemic influenza component. The plan shall also document any actual or recommended collaboration with local, regional, and state public health agencies or officials in the event of an influenza pandemic.

For the text of the entire bill, see http://www.leginfo.ca.gov/pub/05-06/bill/sen/sb_0701-0750/sb_739_bill_20060928_chaptered.html

Download: (.doc) California Adult Vaccine Exemption

Date



School or Governing Authority

Address

City, State, Zip Code



RE: Vaccination Exemption



Dear (Name):



I am writing to request an exemption from (institution name)'s immunization requirements based upon my philosophical objections to the practice of immunization. I am claiming this in accordance with California Health and Safety Code Section 120365, which reads as follows:


Immunization of a person shall not be required for admission to a school or other institution listed in Section 120335 if the parent or guardian or adult who has assumed responsibility for his or her care and custody in the case of a minor, or the person seeking admission if an emancipated minor, files with the governing authority a letter or affidavit stating that the immunization is contrary to his or her beliefs.



This letter serves as my formal request to (institution name) that I be exempt from the required immunizations because this medical practice is contrary to my beliefs. Thank you for your attention to this important matter. If you have any questions do not hesitate to contact me.



Sincerely,



Your Name



Enclosure: (YOUR STATE) Health and Safety Code



Xc: Michael Peabody, Esq., Vice President

Seventh-day Adventist Church State Council

CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
HEPATITIS B VACCINE DECLINATION FORM (University Employees) OSHA
OLD
(.pdf) 1st Web Archive Link
(.pdf) 2nd Web Archive Link
(.pdf) 3rd Web Archive Link
(.pdf) 4th Web Archive Link

Stanford University - Stanford, California
Hepatitis B Vaccine Declination Form (University Employees)
(.pdf) http://www.stanford.edu/dept/EHS/prod/researchlab/bio/docs/Hepat_BVacc_Decl.pdf 

TB Test: Yes; mandated.

However, exemption is allowed, and the exemption is on the back of the CA immunization record pm286b. (.pdf) http://www.cdph.ca.gov/programs/immunize/Documents/pm286b.pdf

University of California, Berkeley - Graduate School of Education - TB Skin Test required.

TB Testing Exemption Letter:
statutes/Laws
New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: statutes/Laws  |   DayCare_Schools_Colleges  |   Letters_Forms_Affidavits  |   (options) OptOutRegistry
Adult Issues: Employment  |   TB_and/or_LeadTesting  |   (options) OptOutRegistry
Misc_Info, Sponsors, etc.

TB and/or Lead Testing

TB-Links/Exemptions

California Specific w/California Health and Safety Code 121475 (b)
HTML [California]
Sample Letter for exemption to TB testing - California TBCalif.htm
MS DOC
Sample Letter for exemption to TB testing - California TBCalif.doc
WordPerfect
Sample Letter for exemption to TB testing - California TBCalif.wpd
PDF
Sample Letter for exemption to TB testing - California TBCalif.pdf

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."

School Employees: (TB test)
Regarding legal requirement, Optional tests and X-ray final determination.
http://law.justia.com/codes/california/2009/hsc/121525-121555.html


The CDC approves, the skin test, and TB blood tests.

Religious Exemption for School Employees: (TB test)
EDUCATION CODE SECTION 49400-49415

49406.
    (g) If the governing board of a school district determines by resolution, after hearing, that the health of pupils in the district would not be jeopardized thereby, this section shall not apply to any employee of the district who files an affidavit stating that he or she adheres to the faith or teachings of any well-recognized religious sect, denomination, or organization and in accordance with its creed, tenets, or principles depends for healing upon prayer in the practice of religion and that to the best of his or her knowledge and belief he or she is free from active tuberculosis. If at any time there should be probable cause to believe that the affiant is afflicted with active tuberculosis, he or she may be excluded from service until the governing board of the employing district is satisfied that he or she is not so afflicted.

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.


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 California

California BEST™ BioMeridian Practitioners:

Mary Kennedy, MA MA
Master/Teacher
Encinitas, California
760-633-3359
grevelle@onemain.com
New! Meridian Stress Assessment - Find out if your organ systems and meridians are in balance using FDA registered technology. If you're out of balance, we can find remedies to assist you in rediscovering your optimum health.

Energy Balance Resources - USA
7710 Balboa Avenue
Suite 323
San Diego, California 92111
866-522-5262
info@4ebr.com
http://www.4ebr.com

Ross Life Centers
Dr. Calvin B. Ross, D.C.
Chiropractor in San Clemente
653 Camino De Los Mares, Suite 103 San Clemente, California, 92673 USA
Telephone (949) 661-9476 or 800-386-3929 - (24 Hr. Answering Service)
FAX (949) 661-7536 - (24 Hr. Fax Line)
http://www.drrossdc.com/
Email: info@DrRossDC.com
Specializing in the Meridian Stress Assessment, (MSA), which is FDA approved.

Jace Wellness Center
Craig Jace, DOM, L.Ac., PA-C, ND
10843 Mangolia Blvd, Ste 1
No. Hollywood, CA 91601
Phone: (818) 505-8610
http://www.jacemedical.com
E-mail: drj@jacemedical.com

The Wellness Doctor
Dr. Kalei N. Campbell, DC
2091 San Joaquin Hills Road
Newport Beach, CA. 92660
Office Manager: Diane Campbell
Voice: (949) 644-0511
Fax: (949) 644-5442
http://www.thewellnessdoctor.com
Email: csd@thewellnessdoctor.com

BioSET™ Institute
Ellen W. Cutler, D.C.
Post Office Box #3
Mill Valley, CA 9494
Phone:
Toll-free: (877) 927-0741
Local: (415) 384-0200
Fax: (415) 384-0199
http://www.drellencutler.com/
E-Mail: admin@bioset-institute.com
BioSET "incorporates muscle testing, detoxification, enzyme therapy, acupressure and the use of Biomeridian's MSA (meridian stress assessment) machine."

South Coast Medical Center for New Medicine, Inc.
Leigh Erin Connealy M.D.
14642 Newport Ave.
Tustin, CA 92780
714-669-4446
http://www.perfectlyhealthy.net
connealymd@earthlink.net

American Herbal Laboratories, Inc.
Dr. Luke Cua, P.H.D., O.M.D., L.A.C.
8526 E. Garvey Ave.
Rosemead, Ca 91770
Tel: (800) 307-0928, (626) 307-0928
Fax: (626) 307-9445
http://www.newvita.com/
Email: herbal@newvita.com

Holistic Nutritional Counseling
Tammy Fish, BSHN
Lake Elsinore, CA 92530
Phone: (951) 907-0488
http://holistic-solutions.org/
info@holistic-solutions.org
New clients receive an initial Meridian Stress Assessment/Bio-feedback testing evaluation including organ-gland-system screening and tests for nutrient deficiencies, food environmental sensitivities, toxicity, and various other health analyses.

Izabela Dimitrova N.D.
Bio Meridian Stress Assessment, Nutritional Counseling, Homeopathy, Herbology
120 S. Swall Dr. Suite 105
LA, CA 90048
Tel: 323 841 2575
Email: beladimitrova@yahoo.com

South Coast Medical Center For New Medicine, Inc.
Two Locations
14642 Newport Avenue, Suite 200, Tustin, CA 92780 (714) 669-4446
23521 Paseo De Valencia, Suite 204, Laguna Hills, CA 92653 (949) 472-3717
http://www.scmedicalcenter.com
New Patient Downloadable Forms:
http://www.scmedicalcenter.com/newpat.htm
Email: info@scmedicalcenter.com
Meridian Stress Assessment (MSA)
A MSA is used to conduct a comprehensive evaluation to determine appropriate ways to achieve healthy energetic balance. This process involves measuring electrical conductivity at responsible points on the skin, typically on the hands and feet. According to energy medicine theory, every disease state is preceded by and indicated by an energy signal detectable by electrodermal screening devices, a report is generated which can assist your doctor in assessing which parts of your body are functioning correctly, and identifies possible pathogens and toxins that are making you sick.

E-Z Health, Inc.
Nectar of the Universe

Patrick Estes & Munie Juan
3243 Balboa St, San Francisco, CA 94121
415-379-3504
Fax (415) 379-3504
http://www.nectaroftheuniverse.com/msa.php
ezhealth@sbcglobal.net
Alternative Healing: N.A.E. T. Allergy Elimination, SKENAR treatments, Toxicity Elimination, Energized Water. Meridian Stress Assessment (MSA) Additional Testing: Once the top twenty organ systems are identified, the patient has several additional testing options. Additional contributing factors that can be tested and evaluated include: Parasites / Heavy Metals / Chemicals / Bacteria / Virus / Fungus / Molds / Herbicides / Pesticides / Mycotoxins / Hormones / Vaccinations / Phenolics / Medication

Dr. Glen Canale
P.O. Box 366
Idyllwild, CA. 92549
USA
P/F +1-909-659 5817
I use several machines in my practice including: EAV, Cymatic Therapy, Molecular Enhancement, Amythst Regenerator, Oxone Therapy, Ray Light Beam, F-Scan, Audio Visual Stimulation, Voice Analysis, QGM Machine, Color Therapy, Swing Master, Juice Therapy, Mini Thumper. I have been trained in Russia, Ukraine, England, and the U.S. My Doctorate is in Cymatic Therapy. I use the Clark Therapy with the use of the F- Scan machine.

California QXCI Practitioners:

http://www.theqxci.com/practitioners.php#northcalifornia

http://www.hope4cancer.com
A clinic in Mexico (Playas de Tijuana, Mexico) which treats cancer and a variety of other aliments. Click on link for available modalities which include Oxygen, Chelation, Electronic Homeopathy, Micor-current Therapy, Rife, Color, etc. They use the QXCI equipment also.

Northern California

Haripriya Dillon
Specializes-Homeopathy, Flower Essences, Herbology, Aromatherapy
Penn Valley, Ca 95946
530-432-2173
haripriya@earthlink.net
Web Address:http://www.bluegreenalgae.com

Ariana Gossfeld
Specializing in flower essences, emotional therapy, gemmotherapy (cellular drainage) and oligo therapy (trace mineral for increased enzymatic activity).
Boulder Creek, CA 95006
831-338-1982
arianaqx@earthlink.net

Lindalee Hatch, CBT, CMT
Certified Biofeedback Therapist, Certified Massage Therapist,
EPFX / QXCI Practitioner
Physical Health and Balance
Fees:
$150 initial 2 hour session
$75 per hour following sessions
Sacramento, CA
916-929-0424

Mary Ann Reith, RN, CBT
House energy clearing
Work with animals
In person or phone consultations available
San Leandro, CA
510-351-5533

Tisha Rivias
EPFX / QXCI Practitioner
Dark Field. Microscopy, Nutrition Massage
Silicon Valley, San Jose, Carmel, Montery, Santa Cruz, Salinas, Central and Northern California
831-710-0091
qxci4all@yahoo.com

Robin Grant
Certified Biofeedback Technician (SCIO/EPFX)
Certified NLP Master Results Coach & Trainer
EFT & Touch for Health Practitioner
San Jose, CA
Cell: 408-316-2079
www.robin-grant.com

Cary Howard, PhD
Consultant in Human Behavior, Certified Clinical Hypnotherapist, Certified Biofeedback Therapist, EPFX / QXCI Practitioner
Habit Control, Expanding Consciousness, Accelerating Learning Skills, Personal Problem Solving, Stress Management Self Help Programs
Fees:
$125.00 for 1 1/2 hour session
Santa Rosa CA
707-538-0547
(cell) 707-483-3261
choward@sonic.net

The Quantum Alliance Inc.
Chandra Giovanni
CONTACT:
Voice Mail: 408-278-5696
Cell: 408-316-7955
Email: cg@quantumsource4life.com
Southern California

Vivien Bonzo
EPFX / QXCI Practitioner
Alternative Healing Technologies to address your needs
Fees:
$250 EPFX / QXCI three hour session
$150 1 1/2 hour session
$175 3 hour distance session
$100 1 1/2 hour distance session
$50 problem specific "mini-session" (distance only)
Los Angeles, CA
626-392-3133

Roopa Chari or Deepak Chari
San Diego, CA
858-689-0513
charicenter@aol.com

Ariana Gossfeld, CBT, CMT
Certified Biofeedback Therapist, Certified Flower Essence Practitioner, Certified Massage Therapist, Certified Triom Biomagnetics Instructor, EPFX / QXCI Practitioner
Spiritual and Emotional Counseling, Gemmotheraphy and Oligotherapy Counsleing
Fees:
$125 initial EPFX / QXCI session
$75 follow up session
$45 Flower Essence Session
$100 Massage
South Bay Area, Santa Cruz Mountain Area, Santa Cruz, CA
28388 Big Basin way
Boulder Creek, CA 95006
831-338-1982
arianaqx@earthlink.net

Marcy Jimenez, CBT
Certified Biofeedback Therapist, EPFX / QXCI Practitioner
Fees:
$150 First Visit
$100 Revisit
Tiujana, Mexico
San Diego, CA
mjmex@hotmail.com
Web Address: www.hope4cancer.com

Dr. HarHari Khalsa
1026 S. Robertson #300
Los Angeles, CA 90035
310-358-0120

Jenna Loren
EPFX / QXCI Health Practioner
Nutrional Therapy and Psychological Therapy
San Diego, CA 92008
760-729-6092

Brigham Lundahl
Alternative Pain Clinic
27251 Commerce Centre Dr. Suite B
Temecula, CA, 92590
909-506-9517

Michael Mohoric
Certified Qigong Teacher, EPFX / QXCI Practitioner
Stress Reduction, Pain reduction, Disease Prevention, Physical, Emotional, and Spiritual issues, Space Clearing
Fees:
$150 for the first, 2 hour session
$90 per hour for follow up sessions
Laguna Area, Orange County, North San Diego County, CA
949-716-2383
mmohoric@earthlink.net

Cheri Reeder, RN, CHT
EPFX / QXCI Therapist, EPFX / QXCI Trainer
Holistic Healing, Reflexology, Reiki Master
Energy Balancing
San Diego, CA 92117
619-743-3181
Toll Free: 877-650-5400

Judy Smith ND, NMD
Body Health
Detox, rebuilding and renewal since 1996
We work with pets too!
New Port Beach/ Costa Mesa, CA 92707
714-662-7613

Herb Stockman, CBT
EPFX / QXCI Practitioner, Certified Biofeedback Therapist
Fibromyalgia, Leaky Gut Syndrome, Chronic Fatigue
Fees:
$125 Initial Calibration
$65 per hour for further sessions or two sessions at $55 each
Irvine, CA
949-857-9394
hstockman@aol.com
Web Address: www.quantum-biofeedback.net

http://www.theqxci.com/practitioners.php#northcalifornia

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.

statutes/Laws
New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: statutes/Laws  |   DayCare_Schools_Colleges  |   Letters_Forms_Affidavits  |   (options) OptOutRegistry
Adult Issues: Employment  |   TB_and/or_LeadTesting  |   (options) OptOutRegistry
Misc_Info, Sponsors, etc.

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

Immunization Tracking System opt out info:
Patient and Parent Rights
http://cairweb.org/images/docs/SIISDisclosureform_MedicalOfficeHandout_REV62111.pdf

It's your legal right to ask:
  • Not to share your (or your child's) registry shot records with others besides your doctor.

  • Not to get shot appointment reminders from your doctor's office.

  • To look at a copy of your or your child's shot records, who has seen the records or to have the doctor change any mistakes.

Form to decline having your child’s immunization information shared:
http://cairweb.org/images/docs/CAIRDeclineFormNewFax.pdf


     - - - - 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


statutes/Laws
New Born Issues: NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits
School-Daycare-Preschool Issues: statutes/Laws  |   DayCare_Schools_Colleges  |   Letters_Forms_Affidavits  |   (options) OptOutRegistry
Adult Issues: Employment  |   TB_and/or_LeadTesting  |   (options) OptOutRegistry
Misc_Info, Sponsors, etc.

Misc Info - Sponsors - Etc.

Dr. Don Grundmann, D.C., M.H., C.C.E.P.
Director - V.I.A.L. - N. California Chapter
Director - San Francisco Bay Area Freedom Law School
Director - American Warrior Ministry
American Independent Party candidate - United States Senate
425 E. Merle Court
San Leandro, Calif. 94577
Office - 510-895-6789
Campaign - 510-433-7000
StopTheIRS@aol.com
TRUTHUSA.ORG
WhiteRoseWellness.com
N. California V.I.A.L. Home Page


Information on this page is sponsored by:



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