KENTUCKY - IMMUNIZATION EXEMPTIONS by State (includes current statutes, letters & forms)IMMUNIZATION EXEMPTIONS by State (includes current statutes, letters & forms)Kentucky Current Statutes & Laws: http://www.909shot.com/state-site/Kentucky.htm Medical & Religious (notarization required on exemption for school children) "Any child whose parents are opposed to medical immunization against disease, and who object by a written sworn statement to the immunization of such child on religious grounds" shall be exempt from immunizations.
Exemption Letters & Forms... 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. Religious Exemption from newborn screening allowed. Ky. Rev. Stat. § 214.155  (.pdf)
http://www.lrc.state.ky.us/KRS/214-00/155.PDF Ky. Rev. Stat. § 214.155(2) (2) Nothing in this section shall be construed to require the testing of any child whose parents are members of a nationally recognized and established church or religious denomination, the teachings of which are opposed to medical tests, and who object in writing to the testing of his or her child on that ground. Vitamin K Injection... The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert. (.pdf) http://www.fda.gov/medwatch/SAFETY/2003/03Feb_PI/AquaMEPHYTON_PI.pdf"WARNING - INTRAVENOUS USE Severe reactions, including fatalities, have occurred during and immediately after the parenteral administration of AquaMEPHYTON® (Phytonadione)."Alternatives to Vitamin K Prophylaxis... Although oral vitamin K is not licensed for use as a drug by the FDA, drops for oral administration are available. Typically, one drop contains 2 mg. of vitamin K. Contact a midwife in your area, or a birthing supply company (such as birthwithlove.com), or Scientific Botanicals (206 527-5521) where your health care provider can order liquid vitamin K directly. Here's another much safer alternative that your chiropractor or naturopath can order for you. http://www.bioticsresearch.com/Products/BioK.htm A good organic whole food diet along with lots of leafy green vegetables is all that is necessary to prevent vitamin K deficiency in newborns. Sample Vaccine Letters Most states now require the Hepatitis B vaccine for newborns. Many parents are also cornered by emergency room personnel during accident visits. Hospitals nationally are under pressure to utilize every opportunity to score a "hit." If your pediatrician understands your views, get him involved with the hospital. As a last resort, protect your right to receive quality care in the following manner. (Usually, you'll never find anybody in the hospital to sign this simple form): "I certify that the (Name of Vaccine)________ vaccine being administered to (Name of Child)_________ is free from all known and yet unknown zoonotic or human viruses or viral fragments and will not cause acute or chronic illness in the recipient due to viral contamination or as a reaction to the components of this vaccine. (Signature of Physician and Date)_________." If you do get a signature, hold on to the form. (Links to model birth plan letter and acceptance of responsibility) Acceptance of Responsibility. http://www.vaclib.org/legal/accept1.htm 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...  (.doc)
Model Letter for Hospital Births (Model11425.doc) Model Birth Plan Letter for Hospital Births. This one is more detailed. You can attach an exemption from immunizations. In some states, there are religious exemptions from newborn screening tests such as PKU, etc... (.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) (.doc)
VaccineTruth.net/letters/Model letter for hospital births for adoptions.doc
The above documents can also be made available in WordPerfect AFFIDAVIT I/We, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being(s), state Citizen(s) of the Kentucky 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. This includes, but is not limited to, any and all, Vaccinations, Shots, Tests for Diseases, Oral Vaccines, Epidermal Patches and in any other way that Live or Killed Bacterium, Viruses, Pathogens, Germs, or any other Microorganisms, may be introduced into or upon (my/our) newborn's body. This written statement to exempt (my/our) newborn from any immunizations, newborn screening, and the Vitamin K shot, because (Iwe) hold genuine and sincere personal religious beliefs which are inconsistent with these medical procedures & experimentation. The practice of vaccination and the injection or application 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 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. The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert. http://www.fda.gov/medwatch/SAFETY/2003/03Feb_PI/AquaMEPHYTON_PI.pdf "WARNING - INTRAVENOUS USE Severe reactions, including fatalities, have occurred during and immediately after the parenteral administration of AquaMEPHYTON® (Phytonadione)."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 injection of carcinogenic substances that can kill. (We / I) {First and Last name(s)}, as the {(parent (s) / guardian(s)} of ______________________(name of newborn child) are exercising (our/my) rights under the First Amendment of the US Constitution, Ky. Rev. Stat. § 214.155(2), and § 214.036 to receive Religious Exemption from Vaccination & testing. (We are/I am) prepared to sue in Federal Court by invoking 42 USC 1983 if Vitamin K injection, Hepatitis B vaccine, and Newborn Screening is forced upon (our/my) child. Applicable law has been interpreted to mean that a religious belief is subject to protection even though no religious group espouses such beliefs or the fact that the religious group to which the individual professes to belong may not advocate or require such belief. Title VII of the Civil Rights Act of 1964 as amended Nov. 1, 1980; Part 1605.1-Guidelines on Discrimination Because of Religion. Our legal rights are guaranteed by the free exercise clause of the First Amendment to the U.S. Constitution. Recent court decisions have upheld the rights of individuals seeking exemptions from immunizations based upon personal and religious reasons. On the U.S. Supreme Court level in Frazee V. Illinois Dept. of Security, 489 U.S. 829, it was found that a state may not deny an exemption simply because a person is not a member of a formal religious organization. The Lord Jesus Christ and Our Creator are the only source of protection of (my body/our bodies) and that of (my/our) family that (I/we) 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) newborn child from any vaccinations, injections and testing of any kind. Rest assured that (my family and I/our family) 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 Kentucky 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___ The above AFFIDAVIT is available in Microsoft Word  (.doc) and WordPerfect  (.wpd) format.Email us at Exemptions Contact Page 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 Postnatal - 2 months (first "well baby" visit): If you do take your new baby to an MD as opposed to a naturopath and/or chiropractor, please be aware and careful of any forms you sign. We're referring to those "Refusal To Vaccinate" forms put out by the American Academy of Pediatrics. Go to this page below and find out why signing this form is very dangerous. We all know about these forms and how they can be used to undermine parental rights... http://www.vaclib.org/legal/donotsign.htm Generic Vaccine Refusal Form from Dr. Sherri Tenpenny's webpage. (.pdf) http://www.nmaseminars.com/files/Vaccine_Refusal_Form.pdf (.doc) http://www.nmaseminars.com/files/SampleVaccineExemptionForm.docState Form Required: Yes. Sworn statements must be attached to form and notarized as required by law. Daycare & Preschools: Use the VacLib-Kentucky.doc and state forms below. Schools: Exemption VacLib-Kentucky.doc - religious exemption statement for Kentucky. May have to turn in to health dept. to get the official Certificate of Religious Exemption, depending on the particular school's requirments. (.doc) VaccineTruth.net/letters/ExemptionVacLib-Kentucky.doc REQUEST FOR RELIGIOUS EXEMPTION (.pdf)
http://dlane.org/downloads/VACEXMPT.pdf Online immunization exemption forms from the KY Department of Education. School Health Forms According to this, a parent presents the state certificate in addition to their sworn statement. Some schools may accept just the sworn statement. Official State Religious Exemption Certificate (parent attaches their sworn statement) (See Exemption VacLib-Kentucky.doc above) Religious Exemption COMMONWEALTH OF KENTUCKY CHILDHOOD IMMUNIZATION LAW Microsoft Word Format (.doc) CERTIFICATE OF RELIGIOUS EXEMPTION (.doc) CERTIFICATE OF RELIGIOUS EXEMPTION Adobe pdf Format (.pdf)
CERTIFICATE OF RELIGIOUS EXEMPTION (.pdf)
CERTIFICATE OF RELIGIOUS EXEMPTION Medical Exemption COMMONWEALTH OF KENTUCKY CHILDHOOD IMMUNIZATION LAW Microsoft Word Format (.doc) CERTIFICATE OF MEDICAL EXEMPTION (.doc) CERTIFICATE OF MEDICAL EXEMPTION Adobe pdf Format (.pdf) CERTIFICATE OF MEDICAL EXEMPTION (.pdf) CERTIFICATE OF MEDICAL EXEMPTION Exemption VacLib-Kentucky.doc - religious exemption statement for Kentucky. May have to turn in to health dept. to get the official Certificate of Religious Exemption, depending on the school. (.doc) VaccineTruth.net/letters/ExemptionVacLib-Kentucky.doc
Ky. Rev. Stat. (.pdf) 214.036 Exceptions to testing or immunization requirement. (.pdf) 214.036 Exceptions to testing or immunization requirement. (.pdf) 214.034 Immunization of children -- Testing and treatment of children for tuberculosis -- Requirement for reception and retention of current immunization certificate by schools and child-care facilities. Summer Camps & Extracurricular Activities: Girl Scouts of Kentuckiana P.O. Box 32335 Louisville, KY 40232 (.pdf) STATEMENT OF EXEMPTION TO IMMUNIZATION LAWOpt-Outs: Military Recruiters: STUDENT OPT OUT FORM regarding the RELEASE OF NAME, ADDRESS, AND TELEPHONE NUMBER TO MILITARY RECRUITERS (.pdf) http://www.militaryfreeschools.org/PDF/optout2.pdfUNDERGROUND ACTION ALLIANCE STUDENT OPT OUT FORM (.pdf) http://www.militaryfreezone.org/opt_out.pdf (.doc) http://veterans4peace.org/opt_out.docSAMPLE ENGLISH - BINGUAL FORMS FOR OPTING OUT Act to Protect Your Privacy from Military Recruiters (.pdf) http://www.afsc.org/pacificsw/documents/Opt-Out-Form.pdf 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) http://www.ccv.org/images/StudentOptOutNotice.PDF (.pdf) http://www.catholiccitizens.org/content/img/f26422/opt%20out%20notice.pdf (.html) http://www.ccv.org/images/StudentOptOutNotice.htm
Entire packet... (.doc) http://www.mfc.org/respect/Website/Links%20on%20Web%20Page/Opt-Out%20Packet.docSTUDENT OPT-OUT NOTICE - Google Search Colleges & Universities: Use the AFFIDAVIT below if your college doesn't have a form nor require the above state forms. It may be edited for your particular situation. Edit as needed... AFFIDAVIT I, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being, state Citizen of the Kentucky 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 and Insert Kentucky College Statute if different from schools to receive Religious Exemption from Vaccination & 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. 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 Kentucky 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___ These Google searches are mostly the college and school exemptions. There are always new forms coming online. Keep a regular check on these to look for newly added forms. Some are for daycare too. The links are the actual keywords that are used. Immunization Exemption Form Vaccine Exemption Form Immunization Waiver Employment: Employee Hepatitis B Vaccination Declination Form Page 12 of the document  (.rtf)
http://ehs.uky.edu/biosafety/forms/attachment_bbp.rtfGeneric Hepatitis B Vaccine Statement:
http://www.nmaseminars.com/files/HepatitisBDeclinationStatement.docMost of these are the Hepatitis B vaccine declination forms, such as the OSHA form. There are hundreds of these forms. Rather than linking to each one, here are the Google Search results for these keywords. There are other vaccines that one can decline that are worded like the OSHA forms. Vaccine Declination Form or Hep B vaccine waiver Fight SpamBots! TB Test: Required for Nursing Program at Big Sandy Community & Technical College TB Testing Exemption Letter: HTMLSample Exemption Letter for TB testing. May be modified to your use. http://www.vaclib.org/letters/TBwaiverGen.htm Microsoft Word Document (.doc)Sample Exemption Letter for TB testing. May be modified to your use. http://www.vaclib.org/letters/TBwaiverGen.doc TB Testing Exemption Letter for Adults: Microsoft Word Document (.doc)Sample Exemption Letter for TB testing. May be modified to your use. http://www.vaclib.org/letters/TBTestingWaiverAdult.doc WordPerfect Document (.wpd)Sample Exemption Letter for TB testing. May be modified to your use. http://www.vaclib.org/letters/TBTestingWaiverAdult.wpd  PDF document (.pdf)Sample Exemption Letter for TB testing. http://www.vaclib.org/letters/TBTestingWaiverAdult.pdf Extra link from Dr. Sheri Tenpenny's webpage: (.pdf) http://www.nmaseminars.com/files/Exemption_for_TB_testing_1_.pdfLead Testing Exemption Letter: HTMLSample Exemption Letter for Lead testing. May be modified to your use. http://www.vaclib.org/letters/Lead_testing_waiverGen.htm Microsoft Word Document (.doc)Sample Exemption Letter for Lead testing. May be modified to your use. http://www.vaclib.org/letters/Lead_testing_waiverGen.doc The above TB and Lead exemption letters courtesy of Deirdre DeVane of Wash DC. Thank you Deirdre! The adult TB letters were edited by Sherri Tenpenny. Thank you Sherri! 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 Kentucky Kentucky BEST™ BioMeridian Practitioners: Natural Choices Carol Perkins, N.D. Meridian Stress Assessment (MSA) 509 Southland Drive in Lexington, KY and 606 W. Main Street in Carmi, IL. Phone: 859-277-5255 Kentucky QXCI Practitioners: http://www.theqxci.com/practitioners.php Gabriela O'Reilly, CBT, CN Holistic Healing Center of Madeira Certified Biofeedback Therapist, Clinical Nutritionist, EPFX / QXCI Practitioner Bio-Energetic Medicine, Wellness Programs, Anti-aging, Nutritionist Fees: $150 for the first session, $75 per hour after the first session Cincinnati, Dayton, Northern Kentucky 513-272-1044 Web Address: www.holisticmadeira.com For information on purchase or lease of the new Quantum Life BioFeedback L.I.F.E. System, please email Donna at Exemptions Contact Page and leave your name, mailing address, phone number and email. If you're inquiring for another interested individual or practitioner, please leave their information. The company will then send information and contact the interested parties. Or you may call 1-888-249-1421. The L.I.F.E. System is also registered with the FDA for safety issues as a Class 2 Biofeedback Device.
VIAL - Kentucky Chapter Elizabeth Elliott, director Louisville, Kentucky 40205 (502) 459-8388 elizabeth@wholefoodhealthyliving.com Elizabeth Elliott Juice Plus+ Fruits, Veggies and Berries in a capsule. "The next best thing to fruits and vegetables" "Juice Plus+ is the number one encapsulated nutritional supplement in the world" 24 hour info line 1-800-942-1260 Place your order today! http://www.wholefoodhealthyliving.com |
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