Vaccination Liberation Information

MAINE - IMMUNIZATION EXEMPTIONS by State (includes current statutes, letters & forms)

IMMUNIZATION EXEMPTIONS by State (includes current statutes, letters & forms)

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


Current Statutes & Laws:
Medical, Religious & Philosophical

For religious or philosophical exemption: "The parent states in writing a sincere religious belief that is contrary to the immunization requirement or an opposition to the immunization for philosophical reasons."

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.

PDF documents (.pdf)

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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.

Vitamin K Injection...

The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert.
"WARNING - INTRAVENOUS USE Severe reactions, including fatalities, have occurred during and immediately after the parenteral administration of AquaMEPHYTON® (Phytonadione)."
Merck Vitamin K Package Insert - Aquamephyton PI | Scribd

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

Alternatives to Vitamin K Prophylaxis...

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

Here's another safe alternative that your chiropractor or naturopath can order for you. Or order directly from

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.

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.

Hepatitis B Vaccine Refusal from Dr. Sherri Tenpenny's webpage:
This form is generic. It can be used in other states.

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) letter for hospital births for adoptions.doc

The above documents can also be made available in WordPerfect (.wpd) format.
Please contact us if you want the model birth plan letters in WordPerfect.

Sample Birth Plan from The Center of Unhindered Living

The birth plan arrangements and letter should be turned in before delievery date.

This "Refusal to Permit Medical Treatment" form is optional to use.

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

It would be ideal to use with the AFFIDAVIT below AND model birth plan letter. We hope prospective parents use these affidavits, model birth plan letters, refusal forms, and succeeds. We would LOVE to hear your success stories. The ACCEPTANCE OF RESPONSIBILITY is imperative in exercising your rights for legal exemptions from forced medical experimentation and legalized bioterrorism. BE prepared to fight for your baby's rights!

Birth plan religious AFFIDAVIT text below. Use with model birth plan letter and/or refusal forms, and edit as needed...

Affidavit - Birth Exemptions
HTML (simple text) Affidavit to modify.

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

You may want to insert a sentence about your state law into the above Affidavit: click here for the link to your state law.
Did not find your state exemption form on our site?
Then try this link to forms for all 50 states and D. of Columbia.

Vaccine Registry Opt-Outs:

Confidentiality of Your Child’s Vaccination Records
FERPA: The Family Educational Rights and Privacy Act

     - - - - 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
(.pdf) Archived letter from

Word-Document (.doc) Archived on

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)


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.


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: 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.

Vaccine Refusal & Exemption Forms

State Form Required: No.

However, one is available from the state Dept of Health. The same form is also available online.
(.doc) exemptionform.pdf
Some schools have their own exemption form.

You may access the state law on immunizations in school at:

Daycare & Preschools:

See State Form ... above

Falmouth, Maine 04105

(.pdf) Medical
(.pdf) Religious and Philosophical

Sanford School Department
917 Main Street, Suite 200, Sanford, Maine 04073
For Religious or Philosophical Beliefs

Maine School District MSAD #55
Official exemption form for Hiram, Maine 04041 school district area.
JLCB-E2 Immunization Exemption Form can be downloaded from here:


School District - M.S.A.D #55 District includes:
Baldwin Consolidated School
Cornish Elementary School
Fred Morrill Elementary School
Hiram Elementary School
South Hiram Elementary School
Sacopee Valley High School

Maine School Administrative District # 34
(.pdf) MSAD 34 Immunization Exemption Form.pdf

(.pdf) Archive: 34 Immunization Exemption Form.pdf

Troy A. Howard Middle School
Maine School Administrative District #34
(See exemption at the bottom of the page.)

North Yarmouth Academy

North Yarmouth Academy
WAIVER OF EXAM: (If choosing not to do physical and date of last exam is greater than 2 years.) This waiver will be valid for one year.
(.pdf) [Archived]

Health Services
130 Wescott Road
South Portland, Maine 04106
(.pdf) IMMUNIZATION EXEMPTION FORM Form good for ALL South Portland Schools.

The above form is for the following schools:

Brown Elementary School
Dyer Elementary School
Kaler Elementary School
Mahoney Middle School
Memorial Middle School
Skillin Elementary School
Small Elementary School
South Portland High School

King Middle School
Portland Public Schools

Colleges & Universities:

The University Of Maine At Machias:
immunization_waiver.pdf    |    (Word) immunization_waiver.doc


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


Maine exemption for health care workers
“No chief administrative officer may permit any employee to be in attendance at work without a certificate of immunization for each disease or other acceptable evidence of immunity to each disease, or documentation of exemption or declination.”

Most 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
Hep B vaccine waiver

TB and/or Lead Testing


Generic letter for Exemption to TB Testing:
HTML (text): Exemption-tb-test.html

MS Doc file: Exemption-tb-test.doc

Standard Interpretations
09/23/1997 - The Bloodborne Pathogen Standard and the Enforcement Procedures for TB.
"Finally, be aware that participation in the employer's skin testing program is voluntary on the part of the employee. OSHA does not require that employees participate in TB skin testing, only that the employer make such skin testing available to employees."
TB and Lead Testing Links:
F L Y E R    LETTER    Exemption_Letters    OSHA_and_TB_test    Tubersol    Treatment    TB_Screening    Alternatives/QuantiFERON_TB_Gold_testimony

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

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

Here are some of the practitioners for Maine

Maine BEST™ BioMeridian Practitioners:

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

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

Maine QXCI Practitioners:

Vaccination Liberation - Idaho Chapter
Contact: Vaccination Liberation

"Free Your Mind....From The Vaccine Paradigm"

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