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Vaccination Liberation Information
Tennessee State Exemption Page
VacLib.org & VaccineTruth.net Exemption Page

Statutes/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


Requirements do not apply to any "child whose parent or guardian files with proper authorities a signed, written statement that such immunization and other preventative measures conflict with the religious tenets and practices of the parent or guardian affirmed under penalties of perjury."

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]



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.

Note: See Newborn Screening requirement for Tennessee

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.

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

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

Replace the paragraph (near bottom of page 1) of the generic AFFIDAVIT above with your state law as follows: [Make sure you replace with your name, status, and name of child.]

(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 and Tennessee Statutes TCA 49-6-5001 (b)(2) 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. Or order directly from Amazon.com

Biotics Research, Bio-K Mulsion - 1 fl oz

A good organic whole food diet along with lots of leafy green vegetables is all that is necessary to prevent vitamin K deficiency in newborns.


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


Tennessee: New Born Screening

IMPORTANT! Please download this if you're expecting a child or know someone who is!
This proves to the hospital that religious exemption is "allowed" for newborn screening in Tennessee.

The form states that you acknowledge that by refusing the newborn screening for religious reasons that you are COMMITTING A MISDEMEANOR:
I have been informed that state law requires this testing and that violation of the law is a misdemeanor.

Nonetheless, I refuse these tests at this time for my newborn baby
_________________________ because such test conflicts with my religious tenets and practices.

Under penalty of perjury, I affirm such refusal because of a conflict with my religious tenets and practices.
details:
Metabolic/Genetic Newborn Screening Program In Tennessee
Refusal Form Page 30 of the pdf file
(.pdf) health.state.tn.us/lab/Directory/Section4.pdf
XI. Refusal to Have Newborn Screening Performed
When a parent refuses the newborn screening test, we ask that you do send in a newborn screening collection form completely filled in and write "REFUSED" on the form, and we will follow up. If a parent refuses the test due to religious reasons, please fill out the NEWBORN SCREENING REFUSAL FORM [Form: section 4-30]
(See Page IV - 25)[instructions], have it notarized, and fax it to Maternal and Child Health at (615) 262-6458.

General USA: New Born Screening
U.S. states now require screening of newborn babies for specific diseases.

Conditions and legal status of "requirement" of newborn to be screened for each state:
National Newborn Screening Status Report - http://genes-r-us.uthscsa.edu/sites/genes-r-us/files/nbsdisorders.pdf

Newborn Genetic Screening Privacy Laws
(includes links to laws for various states)
Archived Copy: http://web.archive.org/web/20130603035608/http://www.ncsl.org/issues-research/health/newborn-genetic-and-metabolic-screening-laws.aspx

Newborn screening From Wikipedia, the free encyclopedia
http://en.wikipedia.org/wiki/Newborn_screening

Federal NewBorn Screening Law (from Families of Spinal Muscular Atrophy)
http://www.fsma.org


Waivers - Take Care In Signing
If you take your new baby to an MD as opposed to a naturopath and/or chiropractor, please be aware of and careful of any forms you sign.

Our WARNING below is about signing (some) state approved and AAP created forms. See this letter from our director, Ingri Cassel, before you consider signing waiver forms.

WARNING!

Dear VacLib Members and Friends -

Wanted to give you all a heads up on state issued exemption forms. I haven't had to deal with this personally for several years, and I always crossed out sentences or clauses, and often adding some of my own, before signing their exemption of medical release type of forms. When Donna Carrillo began to diligently search out existing exemption forms and posting them, I read over a couple of them and encouraged people to make up their own whenever possible. After having a "closer encounter" with such a form - a form provided to the state of Idaho by the American Academy of Pediatrics and the Centers for Disease Control and Prevention and used by licensed Idaho daycares, I was shocked into the VERY REAL danger of signing these forms without changing them significantly.

Any form one affixes their initials to, dates and affixes their signature to at the end is a LEGAL document. All statements prior to your signature you must agree to fully OR restrict your signature to say that you are signing under TDC - threat, duress, and coercion. The form that my daughter was told she needed to fill out for this daycare is posted here: ChildCareExemptForm.pdf. On this form, she crossed out all the "nots" and in her personal statement she further clarified that she understands fully the risks of vaccinating her child.

I have since found out that most public schools and daycares in other states also use a similar form. Basically, by initialing and signing this form as is, you are admitting to understanding that "vaccine preventable" diseases are extremely deadly and ALSO admitting to negligence for willfully denying your son/daughter the life saving protection that vaccines offer. These forms are MEANT to not only be intimidating but to catch the legally ignorant off guard. This is very serious to me since all states have adopted the federally funded Child Abuse Prevention and Treatment Act which gives states the right to literally steal your children for up to 48 hours -- the time they have to prove child neglect OR abuse.

If it were ME, I would insist that they accept a form that I provide them since it satisfies the law. If there are any problems or they insist on me using their form, I would cite the law and ask the school or daycare provider where it actually says in state statute that this particular form is the only form that will satisfy the law. Since your parental rights are at stake here, it is best to be vigilant and err on the side of being overly cautious.


A modified AAP form is posted here that you may wish to use with your doctor: AAPmodified.htm

AAPmodified.doc MSWord .DOC file  |   AAPmodified.pdf PDF file, best for printing.

Not all State employees are aware of the law and many exhibit the Hitler Complex. Take a firm stand. Some individuals have had difficulty getting the required forms. Such arrogance on the part of State employees should be reported to the Director of your state Department of Health.

See:   AnaiRhoads.org Why Signing a Waiver to Avoid Vaccines Can Be Considered Abuse
She is referring to the Refusal To Vaccinate Form developed by The American Academy of Pediatrics, not a regular religious or conscientious exemption letter or form.



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/



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

DayCare
See Tennessee Forms below

Preschool
See Tennessee Forms below

Kindergarten & Schools
See Tennessee Forms below

Tennessee Forms
State Form Required: Yes. TCA 49-6-5001(b)(2) Green Official TN Certificate of Religious Exemption. However, some schools have accepted letters from parents, and some schools have their own exemption form.
Nice clean short form - Use where ever accepted:
STATE OF TENNESSEE DEPARTMENT OF EDUCATION / Model Form Religious Exemption from Vaccination(s) ED-5379
http://www.tn.gov/education/schoolhealth/healthservices/doc/Religious_Immun_Exemp.pdf

Tennessee Immunization Requirements
https://health.state.tn.us/ceds/required.htm

Immunization Program, Registry, etc.
https://health.state.tn.us/ceds/immunization.htm

Schools:

Religious Exemption Letter. In some districts, you may be required to get the Official Tennessee Certificate of Religious Exemption. It's a green form. However,you may use this letter to give the health dept to obtain the green form, if necessary.
Tennessee religious exemption letter.doc (5226)
VaccineTruth.net/letters/Tennessee religious exemption letter.doc

HAMBLEN COUNTY SCHOOLS - Morristown, Tennessee
REQUEST FOR EXEMPTION FROM IMMUNIZATION
Archived Document:
http://www.hcboe.net/main/Dept/director/forms/immunization_exmpt_JGCB.pdf

The following schools accept the HAMBLEN COUNTY SCHOOLS REQUEST FOR EXEMPTION FROM IMMUNIZATION form. All Elementary, Middle, High and Charter Schools in District listed below.

Hamblen County School District
210 East Morris Boulevard
Morristown, TN 37813

Elementary Schools
Alpha Elementary School
5620 Us 11e Hwy, Morristown, TN 37814

Fairview Marguerite Elementary School
2125 Fairview Rd, Morristown, TN 37814

Hamblen County Alternative School
376 Synder Rd, Morristown, TN 37813

Hillcrest Elementary School
407 S Liberty Hill Rd, Morristown, TN 37813

John Hay Elementary School
501 Brittain Court, Morristown, TN 37814

Lincoln Heights Elementary School
215 Lincoln Av, Morristown, TN 37813

Lincoln Heights Presch Center
217 Lincoln Av, Morristown, TN 37813

Manley Elementary School
551 West Economy Rd, Morristown, TN 37814

Russellville Elementary School
5655 Old Russellville Pk, Russellville, TN 37860

Union Heights Elementary School
3366 Enka Hwy. Morristown, TN 37813

West Elementary School
235 W Converse, Morristown, TN 37814

Whitesburg Elementary School
7859 East Andrew Johnson, Whitesburg, TN 37891

Witt Elementary School
4650 South Davy Crockett, Morristown, TN 37813

Middle Schools

East Ridge Middle School
6595 St. Clair Rd, Whitesburg, TN 37891

Hamblen County Alternative School
376 Synder Rd, Morristown, TN 37813

Lincoln Heights Middle School
219 Lincoln Av, Morristown, TN 37813

Meadowview Middle School
1623 Meadowview Ln, Morristown, TN 37814

West View Middle School
One Indian Path, Morristown, TN 37813

High Schools
Hamblen County Adult High School
210 E Morris Bl, Morristown, TN 37813

Hamblen County Alternative School
376 Synder Rd, Morristown, TN 37813

Morristown High East
One Hurricane La, Morristown, TN 37813

Morristown High West
1025 Sulphur Springs Rd, Morristown, TN 37813


AFFIDAVIT for Tennessee Older Child below...
Can be used for daycare, preschools and schools, edit as needed and appropriate for your beliefs.
AFFIDAVIT

I/We, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being(s), state Citizen(s) of the Pennsylvania 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 or the Body of my Children. This includes, but is not limited to, any and all, Vaccinations, Shots, Tests for Diseases, Oral Vaccines, Epidermal Patches and in any other way that Live or Killed Bacterium, Viruses, Pathogens, Germs, or any other Microorganisms, may be introduced into or upon my body or any of my children's bodies.

This written statement to exempt my child from any immunizations, TB testing, and other shots/injections, 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 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.

(We / I) {First and Last name(s)}, as the {(parent (s) / guardian(s)}of _________________________(name of child) are/am exercising our rights under the First Amendment of the US Constitution and Tennessee Statutes TCA 49-6-5001 (b)(2) to receive Religious Exemption from Vaccination.

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

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

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

I affirm that vaccination & injections of any foreign substances and proteins conflict with my religious beliefs as stated above. Therefore, I would request that you accommodate my religious beliefs and practices by exempting my child from any vaccination or injections of any kind.

Rest assured that my family and I do practice a form of immunization that keeps our immune systems strong and is in keeping with Biblical principles.

Further Affiant Saith Not

The use of notary below is for identification only, and such use does NOT grant any jurisdiction to anyone.

Subscribed and sworn, without prejudice, and with all rights reserved, (Print Name Below)


_______________________________________________________________,
Principal, by Special Appearance, in Propria Persona, proceeding Sui Juris.


_______________________________
Signature of Affiant

       ACKNOWLEDGMENT

state of Tennessee

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___

www.utc.edu/student-health-services/if2013.docx

Colleges/Universities
Links to University of Tennessee personal and religious exemptions:
University of Tennessee
Religious Exemption to MMR vaccine
(.pdf) http://www.utc.edu/student-health-services/if2013.docx

Clinical Education Policies
www.utc.edu/physical-therapy/pdfs/clinedpolicies_002.pdf
IMMUNIZATIONS & TB SKIN TEST
PHYSICAL THERAPY DEPARTMENT
DPT STUDENT INFORMATION FORM


East Tennessee State University
Religious Exemption Form:
(.pdf) http://www.etsu.edu/nursing/shserv/documents/MMR_RELIGIOUS_EXEMPTION.pdf

Meningococcal Meningitis and Hepatitis B
Immunization Health History Form
Has a check off for waiver
Hepatitis B/Meningitis Waiver (PDF)
(.pdf) http://www.etsu.edu/nursing/shserv/documents/Hep_B_Waiver.pdf
Hepatitis B/Meningitis Waiver (Word Doc)
(.doc) http://www.etsu.edu/nursing/shserv/documents/Hep_B_Waiver.doc

Tennessee State University
http://www.tnstate.edu/campus_life/healthservices.aspx
Immunization Requirements
The state of Tennessee requires students entering colleges, universities, and technical institutes with enrollment of greater than 200 students to provide proof of two (2) doses of Measles, Mumps, and Rubella (MMR) vaccine on or after the first birthday or proof of immunity to measles.

In compliance with this law, and in an attempt to maintain a safe and healthy campus environment, Tennessee State University requires that all entering students, born after 1957, furnish documented proof of having immunity to measles or having been immunized with two doses of MMR vaccine on or after the first birthday unless contraindicated because of pregnancy, allergy to a vaccine component, or other valid medical reason(s).

The law states that immunizations are not required if they conflict with the parents, or guardians, (or individuals over 18) religious tenets and practices, affirmed under the penalties of perjury.They are also not required if a qualified physician shall certify that administration of such immunization would be in any manner harmful to the child involved. (TCA Section 49-6-5001).

The University of Memphis
Hepatitis B - Meningitis Immunization Health History Form
The State of Tennessee mandates that The University of Memphis provide information concerning the Hepatitis B infection and Meningococcal disease to all students entering The University of Memphis for the first time. The law does not require that you receive either immunization for enrollment. Student Health Services urges our students to be immunized against Meningococcal Meningitis and Hepatitis B.
ALL new students must complete the Hepatitis B - Meningitis Immunization Health History Form before they can register.
Source: http://saweb.memphis.edu/health/immunization/HepB_Men.htm

The University of Memphis
MMR & Varicella
Note: Exemptions may be requested if the student has an allergy to a vaccine component, has a valid medical condition which contraindicates receiving the vaccine, or religious tenets prohibiting vaccinations. If you believe you are entitled to an exemption based on one of the preceding grounds, you must contact Student Health Services at the University of Memphis prior to registration. If an exempted student contracts Measles, Mumps, Rubella, or Varicella, or if a Measles, Mumps, Rubella, or Varicella outbreak occurs, it will be the student’s responsibility to remain off campus until a physician gives written permission for the student to return to campus.
Source: http://saweb.memphis.edu/health/immunization/MMR.htm

Jackson State Community College
2046 North Parkway, Jackson, TN 38301
(731) 424-3520 • (800) 355-5722
Hepatitis B Vaccine Health History & WAIVER
(.pdf) http://www.jscc.edu/uploads/Admissions/hepatitis-B.pdf

Volunteer State Community College
1480 Nashville Pike
Gallatin, TN 37066
Hepatitis B Vaccine Waiver
(.pdf) www.volstate.edu/Admissions/Documents/hepb_waiver_form.pdf

Vanderbilt University:
Student Health Center | Vanderbilt University
Zerfoss Building, MCN | 1161 21st Ave. S. | Nashville, TN 37232

Hepatitis B Vaccine and Meningitis Waiver Forms.
VANDERBILT UNIVERSITY:

(.pdf) Meningococcal Meningitis and Hepatitis B Immunization and Waiver Form

(.pdf) Graduate Student

(.pdf) VANDERBILT MEDICAL CENTER

(.pdf) HQ-Graduate-and-Undergraduate4.pdf

(.pdf) Health Professions Student - No Exemptions mentioned: (Titers ok)

Cumberland University Vaccine Wavier Form
Lebanon, TN 37087-3408
http://www.cumberland.edu/graduate/sm_files/Proof%20of%20Medical%20Vaccinations%20Form.pdf
(c) Where a parent or guardian, or in the case of an adult student, the student, provides to the school a written statement, affirmed under penalties of perjury, that vaccination conflicts with the religious tenets and practices of the parent or guardian, or in the case of an adult student, the student.

... contact the Office of Admissions for a copy of the Medical Vaccination Waiver Form.


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


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

Click here for an Affidavit for Adult (college & employment religious exemption) ... Edit as needed...



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/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.

See QXCI-BioMeridian Providers, etc below


Misc Info - Sponsors - Etc.
Here are some of the practitioners for Tennessee

Tennessee BEST™ BioMeridian Practitioners:

Mind-Body Medical Center
Stephen L. Reisman, MD
2325 Crestmoor Rd. Suite P150
Nashville, TN 37215
Telephone 615-298-2820
Fax 615-298-2770
Offers a holistic approach to healing including nutrition—uses meridian stress assessment to check for energy imbalances in body.

Health & Stress Management Inc.
Dr. Eddi Boyd, RN, ND, PhD.
6949 Charlotte Pike, Suite 204
Nashville TN, 37209
(615) 356 - 5060
http://www.healthandstressmanagement.com
E-Mail: dreddiboyd@comcast.net
Meridian Stress Assessment
I utilize this bio-energetic technique in my office. It uses acupressure points on the body and using a computerized analysis, giving a very accurate and detailed print-out on your own bodies imbalances including; food, airborne intolerances, vitamin-mineral deficiencies, hormonal imbalances, chemical substitutes, organ and system stresses, weaknesses, etc.

South Wellness Center
Dr. Keith South & Lisa South RN BNS
Bio-Meridian Stress Assessment
Executive Park Building
4721 Trousdale Drive Suite 130
Nashville, TN 37220
Office Phone (615) 662-6500
Office Fax (615) 333-3147
http://www.southwellness.com/
drsouth@southwellness.com - For Dr. South
lisa@southwellness.com - For Lisa
melina@southwellness.com - For Melina

Meridian Stress Assessment
Kim Hanson (901) 755-8082
Terry Hanson, DC, (901) 757-9000
2121 Germantown Rd, S., #4
Germantown, TN 38138
NUTRITIONAL THERAPY

Mind-Body Medical Center
Stephen L. Reisman, MD
2325 Crestmoor Rd. Suite P150
Nashville, TN 37215
Telephone 615-298-2820
Fax 615-298-2770
Offers a holistic approach to healing including nutrition—uses meridian stress assessment to check for energy imbalances in body.

Tennessee QXCI Practitioners:

Mary J. Clement, Ph.D., JD/MSW
696B Northup Rd.
Portland, TN 37148 615-206-1553
mjclement@team-national.com
Web Address: www.bold-eagle.com

John Cole or Sharon Parker
105 Pembroke Court
White House, TN 37188
615-661-3956
john@tnbiohealth.com
sharon@tnbiohealth.com

Highland Realm
Deanna Naddy DSN, RN
4411 Hamshire Pike
Hamshire, TN, 68401
931-285-2543
or
229 Warv Circle Suite B-12
Brentwood, TN 32027
615-377-6767
drnaddy@earthlink.net
Web Address: www.highlandrealm.org

http://www.qxciscio.com/qxci-tennessee-tn.html

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.
The L.I.F.E. System is also registered with the FDA for safety issues as a Class 2 Biofeedback Device

Additional help with exemptions in Tennessee
East Tennessee Vaccination Information Network/Tennessee Chapter of Vaccination Liberation