Vaccination Liberation - Information
Legal: Science: Misc: Searches:
Exemptions
  State_Chapter/
Resource_Contacts

Avoid_Vaccinations
Activism
LegalNews
Introduction
Basic_Facts
Package Inserts
Ingredients of Vaccines
Q_and_A
Artificially Sweetened Times
Membership
Books Videos Tapes
100+ Anti-Vax links
Vax_Cartoons
News
Planned_Events
KeyWord_Index
Search_Our_Site
Home_Page
Smallpox Alert!
Vaccination Liberation Information
North Dakota State Exemption Page
VacLib.org & VaccineTruth.net Exemption Page

Statues/Laws
Link to state law.
National Vaccine Information Center:
Link to state law.


For additional help with exemptions, birth plan,etc questions:
Non_Vaccinating_Physicians

Check our Vaccination Liberation State Chapter and other resource organizations page for help in your state.

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


Available Exemptions
Medical  &  Religious  &  Philosophical

PDF documents (.pdf)

A PDF reader is required for PDF Files:
Free Foxit Reader 12 MB file size.

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


Click here for Topical Page Navigation Links

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.
N.D. Cent. Code § 25-17-04

§ 25-17-04. Testing and reporting requirements.
The physician attending a newborn child, or the birth attendant in the case of an out-of-hospital birth, shall provide the parents with written information regarding the nature of the proposed testing and then cause that newborn child to be subjected to testing for metabolic and genetic diseases, in the manner prescribed by the state department of health. A physician attending a patient with a metabolic disease or genetic disease, or both, shall report the case to the state department of health. The testing requirements of this section do not apply if the parents of a newborn child object to the testing.
Source: http://www.legis.nd.gov/cencode/t25c17.pdf

NBS Guidelines for Healthcare Providers Manual
North Dakota Newborn Screening Program
Refusal of Newborn Screening Tests
Refusal Form on Page 7
(.pdf) www.ndhealth.gov/familyhealth/Publications/NBSGuidelinesforHealthcareProviders.pdf

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)

(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, N.D. Cent. Code § 23-07-17.1 (3), and § 25-17-04 to receive Religious Exemption from Vaccination, ALL injections, & testing.

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.

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.


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

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

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

See Birth Plans for more information on avoiding Hep B Vaccination at birth

Eyedrops
Some states require Prophylaxis against Gonococcal OPHTHALMIA NEONATORUM.

A discussion of medical and legal issues regarding Silver Nitrate in the eyes of the newborn is here:
PDF file: Statutory Law USA: Requiring Silver Nitrate in Eyes of Newborns at: http://www.rbs2.com/SilvNitr.pdf
Written by Dr. Ronald B. Standler, attorney in Massachusetts and consultant

Blog type discussion of pros and cons of eyedrops for newborn is here: http://answers.google.com/answers/threadview/id/20050.html


New Born Screening
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


Click here for Topical Page Navigation Links

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 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.


Click here for Topical 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/


Click here for Topical Page Navigation Links

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

DayCare
(.pdf) Early Childhood Facility Immunization Requirements 2012 Exemptions

Childcare facility or school
If your school does not have their own vaccine exemption form, you may use this one from the
North Dakota Department Of Health
"Statement of Exemption to Immunization Law" on bottom of page.
(.pdf) http://www.ndhealth.gov/Immunize/Documents/Providers/Forms/COI05-2012.pdf

"Statement of Exemption to Immunization Law" on bottom of page 1
Page 2, School Attendance (K-12 and College): 2010-2011 School Year Requirements
(.pdf) http://www.ndhealth.gov/Immunize/Documents/Providers/Forms/CertificateofImmunization.pdf
This is their most current 2012 form.



Preschool

Kindergarten & Schools
K - 12
2012‐2013 School Immunization Requirements
http://www.ndhealth.gov/Immunize/Documents/Schools/School_Requirements_2012-2013.pdf

"Statement of Exemption to Immunization Law" on bottom of page.
(.pdf) http://www.ndhealth.gov/Immunize/Documents/Providers/Forms/COI05-2012.pdf


Colleges/Universities
North Dakota University System, Immunization and TB Testing
Exemptions may be provided upon application under established campus procedures if;
(a) immunization is contraindicated by a medical conditions; or
(b) a student's beliefs preclude participation in an immunization program.
http://www.ndus.edu/makers/procedures/sbhe/default.asp?PID=74&SID=6

Most Colleges:
"Statement of Exemption to Immunization Law" on bottom of page 1
Page 2, School Attendance (K-12 and College): 2010-2011 School Year Requirements
(.pdf) http://www.ndhealth.gov/Immunize/Documents/Providers/Forms/CertificateofImmunization.pdf
This is their most current 2012 form.

Minot State University
500 University Avenue West
Minot, ND 58707
See: IMMUNIZATION EXCEPTIONS Page 1
(.pdf) http://www.minotstateu.edu/health/sh_immunization_frm.pdf

North Dakota State University
Measles, Mumps, and Rubella Immunization Requirement
For Medical Exemption Use This one. Check off Medical at the bottom of page.
Measles, Mumps, and Rubella Immunization Documentation
(.pdf) http://www.ndsu.edu/fileadmin/studenthealthservice/mmr.pdf

Certification of Religious, Philosophical or Moral Belief Exception
to the North Dakota State Board of Higher Education
(.pdf) http://www.ndsu.edu/fileadmin/studenthealthservice/religious_exception.pdf

This particular form does ask your reason.
(Explain the basis, in detail, of your religious, philosophical or moral objections to immunization in the space below. You may add extra pages if needed. Identify the length of time you have held this religious, philosophical or moral belief. Also identify whether you are a member of any particular faith, denomination or church which forms the basis for your objection.)
See Our Religion page at:
Also note:
Reasons for objection are commonly that:
  • Vaccines pollute the blood stream
  • Vaccines are created from aborted fetal tissue (murder)
  • Taking fetal tissue into the body is cannibalism
  • It is unethical to to put children at risk by vaccinating
  • Creating vaccines harm animals
  • Taking animal tissue into the body is contrary to vegetarian principles
  • May encourage the belief that one is protected from the results of immoral behavior.
  • Vaccination is a superstition
  •   *Note 1: Vaccinations are NOT Immunizations.
      *Note 2: Non-vaccinated does not mean Non-Immunized. Unvaccinated children have high degrees of immunity.

    Possible inclusions:
    I, {First and Last name}, am exercising my rights under the First Amendment of the US Constitution and N.D. Cent. Code § 23-07-17.1 (3) to receive Religious Exemption from Vaccination & testing.

    FOURTH AMENDMENT [U.S. Constitution] - 'The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized.'

    United Tribes Technical College
    (.pdf) United Tribes Technical College Immunization/Exemption Form (On United Tribes website)

    The University of North Dakota
    Information and Form page:
    http://und.edu/health-wellness/student-health/forms.cfm


    There is a space for Conscientious Exemption on this form:
    (.pdf) Mandatory Health History & Immunization Form and TB Screening Form


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

    Click here for Topical Page Navigation Links

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

    North Dakota Immunization Information System (NDIIS)
    http://www.ndhealth.gov/Immunize/NDIIS/

    In North Dakota health-care providers are required to enter child and adolescent data into the NDIIS, but adult vaccines are not required to be entered.
    Source: http://www.ndhealth.gov/Immunize/NDIIS/Rates.htm

    KNOW YOUR RIGHTS
    Confidentiality of Your Child’s Vaccination Records
    FERPA: The Family Educational Rights and Privacy Act
    http://www.vaxchoicevt.com

         - - - - Other Opt-Outs - - - -:

    Birth Certificate and Marriage License Opt-Out:

    Did you know that you can REFUSE to sign the hospital birth certificates and that there is no law that requires you to do so?
    See: Marriage Licenses, Birth Certificates & #SSNs

    Military Recruiters:

    STUDENT OPT OUT FORM regarding the
    RELEASE OF NAME, ADDRESS, AND TELEPHONE NUMBER TO MILITARY RECRUITERS
    (.pdf) Archived letter from www.militaryfreeschools.org

    UNDERGROUND ACTION ALLIANCE STUDENT OPT OUT FORM
    Word-Document (.doc) Archived on VacLib.org: http://veterans4peace.org/opt_out.doc

    SAMPLE ENGLISH - BILINGUAL FORMS FOR OPTING OUT
    Act to Protect Your Privacy from Military Recruiters
    Information links and forms at AFSC site

    STUDENT OPT-OUT - Google Search

    STUDENT OPT-OUT NOTICE regarding the instruction of sexuality to children:
    STUDENT OPT-OUT NOTICE Valid in all 50 states
    PDF-file (.pdf) http://www.catholiccitizens.org/content/img/f26422/opt%20out%20notice.pdf

    STUDENT OPT-OUT NOTICE - Google Search


    Click here for Topical Page Navigation Links

    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


    Click here for Topical Page Navigation Links

    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.

    North Dakota BEST™ BioMeridian Practitioners:

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

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

    North Dakota QXCI Practitioners:

    http://www.theqxci.com/information.php

    Web Archive Link


    Click here for Topical Page Navigation Links

    Misc Info - Sponsors - Etc.
    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.

    Information on this page is provided and sponsored by:

    Trans-D Tropin