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Vaccination Liberation Information


Louisiana State Exemption Page
VacLib.org & VaccineTruth.net Exemption Page


Statutes/L A W S
Link to state law.
National Vaccine Information Center:
NVIC link to state law.


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

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


- - - Available Exemptions - - -
Medical  &  Religious  &  Philosophical/Other


Exemption requirements:
RS 46:231.4
"If the student or his parent or guardian submits either a written statement from a physician stating that the procedure is contraindicated for medical reasons, or a written dissent from the student or his parent or guardian is presented," the child will be exempted from vaccination requirements.

To confirm the above information, see this link:
http://www.legis.la.gov/Legis/Law.aspx?d=79952

However, recipients of public assistance may only use the religious exemption
RS 46:231.4
A. The secretary of the Department of Children and Family Services and the secretary of the Department of Health and Hospitals shall require each recipient of public assistance of the programs .......

C. No person shall be required to comply with the provisions of this Section if that person or his parent or guardian submits a written statement from a physician stating that the immunization procedure is contraindicated for medical reasons or if the person or his parent or guardian objects to the procedure on religious grounds.
http://legis.la.gov/legis/Law.aspx?d=100601


Your Choice.
Join thousands of other pioneers in refuting the presumed authority the corporate government has over your life.
Break the presumptions by negating adhesion contracts. Find out if your state's corporate statutes actually apply to you. Did you sign a contract binding you to adhere to their statutes? Not likely. To learn more, go to this page.

PDF documents (.pdf)

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

Related Pages


State Resource Individuals

Finding Non_Vaccinating_Physicians


Information below on the left with a yellow background is Specific to your state. Information below on the right with a light grey/blue background is general information.
Page_Navigation_Links
New Born
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.

  • The "Refusal to Register Live Birth" form below is also optional.

Birth Plans (To be used with hospitals and/or midwives)
(Links to model birth plan letters)

Model Birth Plan Letter for Hospital Births. You can attach an exemption from immunizations. In some states, there are religious exemptions from newborn screening tests such as PKU, etc...

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

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

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

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

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

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

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


The birth plan arrangements and letter should be turned in before delivery date.
This "Refusal to Permit Medical Treatment" form below is optional.

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


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

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

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

Vitamin K Injection...

The Question of Vitamin K for Newborns
"Essentially all human infants are born with very low blood levels of vitamin K and, since low amounts of vitamin K crosses into breast milk, levels remain low for several weeks after birth in breastfed babies. The purpose of this natural, universal experience of low vitamin K levels in newborns is not known. ..."
"Mouse and epidemiologic studies indicate that the neonatal “deficiency” of vitamin K, which promotes cell turnover, may actually protect the developing fetus from damaging substances that “escape the primary placental screen.”
Read the rest of the article here:
http://www.thevaccinereaction.org/2016/08/the-question-of-vitamin-k-for-newborns/

The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert.
http://fdb.rxlist.com/drugs/drug-9003-Aqua-Mephyton+Inj.aspx?drugid=9003&drugname=Aqua-Mephyton+Inj
"The injectable form of vitamin K can rarely cause severe (sometimes fatal) allergic reactions when given by injection into a muscle or vein. Therefore, vitamin K should be injected into a muscle or vein only when it cannot be given by injection under the skin or taken by mouth, or when your doctor has judged that the benefit is greater than the risk. Seek immediate medical attention if you experience symptoms of an allergic reaction such as rash, itching, swelling, dizziness, or trouble breathing."
Potential exists for the newborn to experience hypersensitivity to any component of this medication.
Each milliliter contains: Phytonadione ............. 2 mg or 10 mg
Inactive ingredients:
Polyoxyethylated fatty acid derivative ................... 70 mg
Dextrose...................................................................... 37.5 mg
Water for Injection, q.s. .................................................. 1 mL
Added as preservative: Benzyl alcohol ...................... 0.9%

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

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

Alternatives to Vitamin K Prophylaxis...

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

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

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

Or buy direct from Amazon.com:

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.

More Information:
Daily Med - Package Insert:
http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=e8808230-2c44-44c6-8cab-8f29b6b34051

VRM: First Strike – The Dark Side of The Vitamin K Shot
http://vaccineresistancemovement.org/?p=6547

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

State specific information
Religious Exemption from newborn screening allowed.
La. Rev. Stat. Ann. § 40:1299.1

§1299.1. Tests A.(1) A.(1) The physician attending a newborn child, or the person attending a newborn child who was not attended by a physician, shall cause the child to be subjected to tests for phenylketonuria, congenital hypothyroidism, sickle cell diseases, biotinidase deficiency, congenital adrenal hyperplasia, carnitine uptake defect, long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency, medium-chain acyl-CoA dehydrogenase deficiency, trifunctional protein deficiency, very long-chain acyl-CoA dehydrogenase deficiency, glutaric acidemia type I, 3-hydroxy-3-methylglutaryl-CoA lyase deficiency, isovaleric acidemia, 3-methylcrotonyl-CoA carboxylase deficiency, methylmalonic acidemia (CBL A,B), beta ketothiolase, methylmalonic acidemia (MUT), propionic acidemia, multiple carboxylase deficiency, argininosuccinate acidemia, citrullinemia type I, homocystinuria, maple syrup urine disease, tyrosinemia type I, and other genetic conditions that have been approved by the Department of Health and Hospitals; however, no such tests shall be given to any child whose parents object thereto. Effective July 1, 2007, cystic fibrosis shall be included in the tests that the newborn child shall be subject to by the physician attending the newborn child or the person attending the newborn child who was not attended by a physician.

http://law.justia.com/codes/louisiana/2011/rs/title40/rs40-1299-1

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/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


Page_Navigation_Links
Waivers: Read - Modify or Do Not Sign
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!

To ALL who choose to partially vaccinate or NOT vaccinate their children:

We (here in Idaho) are hearing more reports of schools and daycares across our state not honoring legal and valid vaccine exemptions. The following article contains very important information as to why you do NOT want to sign AAP's (state adopted) exemption form: http://childhealthsafety.wordpress.com/2014/03/04/
why-you-must-not-sign-a-refusal-to-vaccinate-form-at-least-if-you-want-to-keep-your-kids-that-is/


Filing a NO Vaccination Notice – for patients, employees and students (Your_Choice)

Older letter regarding exemptions in Idaho (similar to many states today)

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 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.


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

Link to Refusal to Permit Medical Treatment form

Links to Affidavit - Birth

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


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

Affidavit for Parents Participating in International Adoption (Word) (pdf)
Hep B vaccine in hospital for newborn refusal, sample (pdf)
OSHA Declination Statement Form (also, pdf)
Religious exemption letter that was approved in Florida (Word) (pdf)
School Vaccine Exemption Form, sample (Word) (pdf)
TB testing refusal, sample (pdf)
Childcare and School Immunization Requirements

http://drtenpenny.com/forms/

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

Short Sample Vaccine Letter

Most states now require the Hepatitis B vaccine for newborns. Many parents are also cornered by emergency room personnel during accident visits. Hospitals nationally are under pressure to utilize every opportunity to score a "hit." If your pediatrician understands your views, get him involved with the hospital. As a last resort, protect your right to receive quality care in the following manner. (Usually, you'll never find anybody in the hospital to sign this simple form):

"I certify that the (Name of Vaccine)________ vaccine being administered to (Name of Child)_________ is free from all known and yet unknown zoonotic or human viruses or viral fragments and will not cause acute or chronic illness in the recipient due to viral contamination or as a reaction to the components of this vaccine. (Signature of Physician and Date)_________."

If you do get a signature, hold on to the form.

The ACCEPTANCE OF RESPONSIBILITY is imperative in exercising your rights for legal exemptions from forced medical experimentation and legalized bioterrorism. DO be prepared to fight for your baby's rights!
An index page to various Acceptance of Responsibility) forms is here:
. http://www.vaclib.org/legal/accept.htm

Religious exemption forms will be listed below under Daycare Schools Colleges

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/


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

DayCare
See Schools below.

Preschool
See Schools below.

Kindergarten & Schools
State Form Required: No.

Exemptions include: parent/guardian waivers for religious or personal reasons, written statement from physician stating contraindicated medical reasons, shortage of supply of vaccine.

Sample Vaccine Exemption Statement for Louisiana for Philosophical reasons
You can modify for religious reasons.
(.doc) VaccineTruth.net/letters/Louisiana.doc

Sample letter created by a school and scanned is on this web site. Suggest you leave out the line about chicken pox.
http://heartruth.info/2014/11/06/shots-are-not-mandatory-for-school/

http://legis.la.gov/Legis/Law.aspx?d=79952
Excerpt:
§170. Immunization of persons entering schools, kindergartens, colleges, proprietary or vocational schools, and day care centers for the first time; immunization of persons entering sixth grade; electronic transmission of immunization compliance reports
...
E. No person seeking to enter any school or facility enumerated in Subsection A of this Section shall be required to comply with the provisions of this Section if the student or his parent or guardian submits either a written statement from a physician stating that the procedure is contraindicated for medical reasons, or a written dissent from the student or his parent or guardian is presented.

F. In the event of an outbreak of a vaccine-preventable disease at the location of an educational institution or facility enumerated in Subsection A of this Section, the administrators of that institution or facility are empowered, upon the recommendation of the office of public health, to exclude from attendance unimmunized students and clients until the appropriate disease incubation period has expired or the unimmunized person presents evidence of immunization.

Sample Vaccine Exemption Statement for Louisiana for Medical reasons

Statement of Exemption:

Under Louisiana Revised Statutes 17:170 Sec E, I hereby claim exemption from the immunization requirement for Medical reasons.
(Physician statement for dissent for medical reasons attached.)

I understand that in the event of an outbreak of a vaccine-preventable disease at the location of the educational institution or facility the student attends, the administrators of the educational institution or facility, upon the recommendation of the office of public health, may exclude the student from attendance until the incubation period has expired or I present evidence of immunization.

_____________________________ Student signature
_____________________________ Date
_____________________________ Parent or Guardian's signature (if required)



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/



Colleges/Universities

Generally, most colleges should have their own exemption waiver. Some colleges may ask for an additional statement to be attached.   If so, you may use the AFFIDAVIT for Louisiana Adult (college & employment religious exemption) below. The AFFIDAVIT below is sufficient for a religious exemption statement from MMR and any other vaccines to post secondary institutions.

Most colleges now have their mandatory waiver for meningitis. The required documentation informs the postsecondary school, and thus the state, that the student has either been vaccinated for meningococcal meningitis or has chosen to decline the vaccine.

All of Louisana colleges and universities have a mandatory form entitled
Proof of Immunization Compliance (Louisiana R.S. 17:170 Schools of Higher Learning)
On this form you can check off your exemption and sign. They do ask for the reason to be stated, so you can put it there, or use the AFFIDAVIT as an attachment, if you need to.

If your college or university does not give you the required form, you may use this generic form.
(.doc) Proof of Immunization Compliance (Louisiana R.S. 17:170 Schools of Higher Learning)

The section is worded like this...
REQUEST FOR EXEMPTION

If you request an exemption for medical or personal reasons, please check the appropriate blank and provide the information requested. You must state a reason for exemption in the space below.
Medical (Physician’s statement below)
Personal (State reason below)
__________________________________________________________________________

__________________________________________________________________________
I understand that if I claim exemption for personal or medical reasons, I may be excluded from classes (unexcused absences) and other campus activities in the event of an outbreak of measles, mumps, rubella or diphtheria until the outbreak is over or until I submit proof of immunization.

__________________________________________________________________________
Student’s Signature                                                                                            Date

__________________________________________________________________________
Parent or guardian’s signature if the student is under 18 years old                   Date
Links to Education, RS 17:170, 17:170.1, 17:170.2, 17:170.3 and 17:170.4 can bed found hee:
Title RS 17.education


Louisiana Colleges and Universities forms can be found via this Google Search:
Proof of Immunization Compliance (Louisiana R.S. 17:170 Schools of Higher Learning)

Some of the colleges and universities have the same form listed more than once with different URL's. They are all listed for your convenience.

Office of Graduate Studies and Research
Monroe, Louisiana 71209-0600
Proof of Immunization and/or exemption
http://www.ulm.edu/enroll/IForm.pdf. (.pdf)


DEPARTMENT OF FINANCE
2163 CEBA
E.J. OURSO COLLEGE OF BUSINESS ADMINISTRATION
LOUISIANA STATE UNIVERSITY
BATON ROUGE, LA 70803 USA
Proof of Immunization Compliance (LOUISIANA R.S. 17:170 SCHOOLS OF HIGHER LEARNING)
REQUEST FOR EXEMPTION On Page 2
(.pdf) http://www.bus.lsu.edu/finance/programs/files/mastersWEB10.pdf
(.doc) http://www.bus.lsu.edu/finance/programs/files/mastersWEB.doc

Nicholls State University
Thibodaux, LA 70310
Exemptions checked on Page 1 and 2:
(.pdf) http://www.nicholls.edu/health/files/2006/12/immunization_form.pdf

Nicholls State University
University Health Services
Betsy Cheramie Ayo Hall
P.O. Box 2054
Thibodaux, LA 70310
(.pdf) http://www.nicholls.edu/health/wp-content/uploads/2006/12/immunization_form.pdf

University of Louisiana Monroe
Office of Student Services
Monroe, LA 71209-1116
(.pdf) http://www.ulm.edu/enroll/IForm.pdf
(.pdf) https://www.applyweb.com/apply/ulm/Immune.pdf

South Louisiana Community College
Lafayette Campus
Admissions: EMT-P
320 Devalcourt St.
Lafayette, LA 70506
and
New Iberia Campus
908 Ember Drive
New Iberia, LA 70560
PROOF OF IMMUNIZATION COMPLIANCE
(Louisiana R.S. 17:170 Schools of Higher Learning)
Page 7
(.pdf) http://www.solacc.edu/sites/default/files/admissions/lctcs_proof_of_immunization_compliance_4-3-13.pdf

Bossier Parish Community College
(.pdf) http://www.bpcc.edu/admissions/forms.html#forms

McNeese State University
4205 Ryan Street, Lake Charles, LA 70609
Page 5 Of Application Packet.
(.pdf) http://www.mcneese.edu/files/admissions/2011_2012_app_imm.pdf

Our Lady of The Lake College
(.pdf) http://www.ololcollege.edu/assets/uploads/ImmFormRevision.pdf
Waiver of meningitis vaccine:
(.pdf) http://69.2.57.119/pdfs/adobe%20files/waiver.pdf

Louisiana State University - Eunice
Request for Exemption from Immunization Requirement on Page 2
(.pdf) http://web.lsue.edu/apply/immunize.pdf

SOUTHERN UNIVERSITY
and
Agricultural & Mechanical College
PROOF OF IMMUNIZATION COMPLIANCE (Louisiana R.S. 17170 Schools of Higher Learning)
REQUEST FOR EXEMPTION On Page 1
(.pdf) http://www.subr.edu/assets/docs/Admissions/immunization09.pdf
"I understand that my health could be negatively affected and my life possibly endangered by not receiving the above listed vaccines. The reason for not being vaccinated is:"
Note: It would be advisable to cross out the "not", in the above sentence, as you would admitting neglect otherwise.
The reason that most request exemptions in the first place is because health is negatively affected BY VACCINES. "I understand that my health could be negatively affected and my life possibly endangered by not receiving the above listed vaccines. The reason for not being vaccinated is:"

Read carefully and think twice about signing this Immunization Waiver Addendum
The following sentence makes no sense...
"I understand that in the event of an outbreak or warning of an outbreak of any of the immunizations that I have refused will result in me:..."
An outbreak of any of the immunizations?! Do they mean to say "an outbreak or warning of any of the diseases that immunizations prevent will result in me:…" ?!
We would edit that sentence to say... “an outbreak or warning of any of the diseases that immunizations allegedly prevent will result in me:…” You might ask to see the state law that requires signing an immunization waiver addendum. See more about incriminating forms here

tulane.edu/health/upload/Proof-of-Immunization.pdf Tulane University Check Exemption bottom of Page 2
Tulane University in New Orleans, LA
(.pdf) http://tulane.edu/health/upload/Proof-of-Immunization.pdf

Graduate School of Public Health and Tropical Medicine
(.pdf) https://tulane.edu/health/upload/Proof-of-Immunization.pdf

If your college or university is not listed, do a Google search. Louisiana Colleges and Universities forms can be found via this Google Search:
Proof of Immunization Compliance (Louisiana R.S. 17:170 Schools of Higher Learning)

Here are some reasons to put into those spaces on the above forms.

Good religious reasons...
These constitute good reasons when a school or college asks for your religious reason on a form that says, state your reason here or attach rationale.

Oftentimes, you will be requested to state your rationale for your vaccination exemption petition. What follows is what is used for public schools, parochial schools, private colleges, and public universities.

Q: What constitutes a religious conflict with vaccination?

A: All vaccines are made in violation of God’s Word. Vaccines are made with toxic chemicals that are injected into the bloodstream by vaccination. All vaccines are made with foreign proteins (viruses and bacteria), and some vaccines are made with genetically engineered viral and bacterial materials.

A conflict arises if you believe that man is made in God’s image and the injection of toxic chemicals and foreign proteins into the bloodstream is a violation of God’s directive to keep the body/temple holy and free from impurities.

Vaccines are produced in animal tissues. A conflict arises if you accept God’s warning not to mix the blood of man with the blood of animals. Some vaccines are produced in aborted fetal tissue.

A conflict arises if your religious convictions are predicated on the belief that all life is sacred. God’s commandment “Thou Shall Not Kill” applies to the practice of abortion. When it is believed that the practice of abortion should not be encouraged or supported in any manner, a conflict may arise with vaccines produced in aborted fetal tissue even though you didn’t have anything to do with the abortions from which the vaccines are made from.

The Hepatitis-A vaccine containing MRC-5 is obtained from human babies that were electively aborted. WI-38 was created from the tissue of an aborted fetus and is used for the rubella portion of the MMR-II vaccine. RA 273 was created from the tissue of an aborted fetus, and is used for MMR-II vaccine. A conflict arises because my religious convictions are predicated on the belief that all life is sacred. God's commandment "Thou Shall Not Kill" applies to the practice of abortion. The acceptance of this/these vaccine(s) promotes/promote abortion and violates the Sixth Commandment of "Thou Shall Not Kill".

The Chickenpox (Varivax) vaccine containing MRC-5 and RA 273, is obtained from human babies that were electively aborted. The acceptance of this vaccine promotes abortion and violates the Sixth Commandment of "Thou Shall Not Kill".

The Hepatitis-B vaccine protects against a disease that is only transmitted through multiple sexual partners or street IV drug users. The acceptance of this vaccine promotes sexual promiscuity and immoral behavior in direct contradiction to the teachings of my faith.

For a child under age 18, where parent has to make the statement, concerning Hep B vaccine...
The Hepatitis-B vaccine protects against a disease that is only transmitted through multiple sexual partners or street IV drug users and therefore usurps my parental authority to condemn such activity in my child. The acceptance of this vaccine promotes sexual promiscuity and immoral behavior in direct contradiction to the teachings of our faith.

”I believe that inherent in each individual is an innate intelligence, provided by God, which will protect the host environment and provide homeostasis.” “Life and physical health are precious gifts entrusted to us by God. We must take reasonable care of them…” [2288 – Catechism of the Catholic Church 1994]

“The virtue of temperance disposes us to avoid every kind of excess: the abuse of … medicine.” [2290 – Catechism of the Catholic Church 1994]

(Indicate rationale and attach statement from clergy or other authority.)
You do not need to belong to a church or religious organization to claim religious exemption from vaccines.

Applicable law has been interpreted to mean that a religious belief is subject to protection even though no religious group espouses such beliefs or the fact that the religious group to which the individual professes to belong may not advocate or require such belief. Title VII of the Civil Rights Act of 1964 as amended Nov. 1, 1980; Part 1605.1-Guidelines on Discrimination Because of Religion.

Our legal rights are guaranteed by the free exercise clause of the First Amendment to the U.S. Constitution. Recent court decisions have upheld the rights of individuals seeking exemptions from immunizations based upon personal and religious reasons. On the U.S. Supreme Court level in Frazee V. Illinois Dept. of Security, 489 U.S. 829, it was found that a state may not deny an exemption simply because a person is not a member of a formal religious organization.

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

Here's what was used to search for Louisiana college and university forms...
Proof of Immunization Compliance (Louisiana R.S. 17170 Schools of Higher Learning) - Google Search


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

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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.armenianchurchlibrary.com/files/national_opt-out.pdf

STUDENT OPT-OUT NOTICE - Google Search

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 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


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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/Additional_Information

The above TB and Lead exemption letters are courtesy of Deirdre DeVane of Wash DC. Thank you Deirdre!
The adult TB letters were edited by Sherri Tenpenny. Thank you Sherri!

TB can be detected by biofeedback machines that are hooked up to a computer, such as the QXCI, Best BioMeridian MSAS (Meridian Stress Assessment) or Electro Dermal Screening, Quantum Life System, and the F-Scan. You will need to ask specifically for a pathogen scan, especially TB. You will also need to request a printout with the results.

See below in Misc some QXCI, etc practitioners.

Misc Info - QXCI - Etc.
General Information
QXCI SCIO EPFX Overview
(The SCIO and the EPFX are the same device.
It is known as the EPFX in the USA and the SCIO world wide.)
Source:
http://www.energymedicinereview.com/qxci-scio-epfx.html

National (USA) search results for EPFX (QXCI) / SCIO Practitioners.
http://www.alternativesforhealing.com/cgi_bin/practitioner-epfxqxciscio.php


Use Google or other search engine to find a BioMeridian Practioner in your area.

If you do not find one near you, you might use this contact page:
http://www.ihtbio.com/ihtblog/contact-support/

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