Vaccination Liberation Information

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

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

Washington

Current Statutes & Laws:
http://www.909shot.com/state-site/Washington.htm
Medical, Religious & Philosophical

Submit a written certification signed by any parent or legal guardian of the child or any adult in loco parentis to the child that the religious beliefs of the signator are contrary to the required immunization measures; OR A written certification signed by any parent or legal guardian of the child or any adult in loco parentis to the child that the signator has either a philosophical or personal objection to the immunization of the child.

PDF documents (.pdf)

A special reader, Acrobat Reader software for Windows(TM), Macintosh(TM), MS-DOS(TM), SGI(TM), and Sun(TM) is required and is available free from Adobe.

Download Acrobat Reader:


Exemption Letters & Forms...

Birth Exemptions:

For those who are planning a hospital birth but want to evade invasive routine post natal procedures such as a Hep B shot, vitamin K injection, newborn screening, or the application of silver nitrate in the newborn's eyes, a very specific birthing plan must be submitted to the hospital in advance of the birth. Hospital staff must be informed, in advance, of your needs, wants and desires where your baby and birthing experience are concerned. The same applies to midwives.

Religious Exemption from newborn screening allowed.
Wash. Rev. Code § 70.83.020

RCW 70.83.020
Screening tests of newborn infants. It shall be the duty of the department of health to require screening tests of all newborn infants before they are discharged from the hospital for the detection of phenylketonuria and other heritable or metabolic disorders leading to mental retardation or physical defects as defined by the state board of health: PROVIDED, That no such tests shall be given to any newborn infant whose parents or guardian object thereto on the grounds that such tests conflict with their religious tenets and practices.

[1991 c 3 § 348; 1975-'76 2nd ex.s. c 27 § 1; 1967 c 82 § 2.]

http://apps.leg.wa.gov/RCW/default.aspx?cite=70.83.020

Print version...

http://apps.leg.wa.gov/RCW/default.aspx?cite=70.83.020

IMPORTANT! Please download this if you're expecting a child or know someone who is!
The Washington State Newborn Screening Program
Health Care Provider's Manual
http://www.doh.wa.gov/EHSPHL/PHL/Newborn/pubs/hcpmanual.pdf
Parental Right to Refuse
(iv) The legal right of parents or responsible parties to refuse testing because of religious tenets or practices as specified in RCW 70.83.020
PARENTAL RIGHT TO REFUSE

According to law (Chapter 70.83 RCW – PHENYLKETONURIA AND OTHER PREVENTABLE HERITABLE DISORDERS), a newborn screening specimen should not be obtained on any newborn infant "whose parents or guardians object thereto on the grounds that such tests conflict with their religious tenets and practices". If parents do refuse, it is the responsibility of the health care facility to obtain the signature from the parent(s) on the reverse side of the screening card to document the refusal. The provider must make certain that the parent(s) understand the risks of refusing the screening. As with collected specimens, the demographic information should be completed and the signed card forwarded to the Newborn Screening Program within 24 hours. The refusal should be noted in the infant's medical record.

It is important to note that religious reasons are the only valid basis for refusal. Newborn screening statistics indicate that the majority of infants whose parents signed a refusal in the hospital were later tested, indicating that the initial refusal was not truly based on religious principles. Affected infants could have a delayed diagnosis for several days or possibly weeks, thus placing them at significant risk of permanent damage or possibly death. The risk of refusal should be made clear to parents and refusals should not be accepted for any other reason.

This proves to the hospital that religious exemption is allowed for newborn screening in Washington State. It can and should be used with the Model Birth Plan letters. Since there is no refusal form or religious exemption form in the manual, you will need a typed religious exemption affidavit to go along with the Model Birth Plan letter. It is important to cite the state code RCW 70.83.020

Vitamin K Injection...

The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert.
(.pdf) http://www.fda.gov/medwatch/SAFETY/2003/03Feb_PI/AquaMEPHYTON_PI.pdf
"WARNING - INTRAVENOUS USE Severe reactions, including fatalities, have occurred during and immediately after the parenteral administration of AquaMEPHYTON® (Phytonadione)."
fatalities=death
The package insert should be printed out and used along with the model birth plan letter, copy of the statute on newborn screening out of the manual (below...), 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 birthwithlove.com), or Scientific Botanicals (206 527-5521) where your health care provider can order liquid vitamin K directly.

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

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

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

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) http://www.scpie.com/riskmgmt/forms/refusal_treatment.pdf

It would be good idea to use with the AFFIDAVIT AND model birth plan letter (below).

Sample Vaccine Letters

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

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

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

(Links to model birth plan letter and acceptance of responsibility)
Acceptance of Responsibility. http://www.vaclib.org/legal/accept1.htm

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

(.doc) Model Letter for Hospital Births (Model11425.doc)

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

(.doc) Model letter for hospital births 2.doc (11426)

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

(.doc) VaccineTruth.net/letters/Model letter for hospital births for adoptions.doc

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

Hepatitis B Vaccine Refusal from Dr. Sherri Tenpenny's webpage:
(.pdf) http://www.nmaseminars.com/files/Hep_B_in_the_hospital_1_.pdf
This form is generic. It can be used in other states.

Sample Birth Plan from The Center of Unhindered Living

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

We hope someone uses this affidavit, model birth plan letter and refusal forms, and succeeds. We want to hear about it when someone is successful with this. 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!

Email us for a typed affidavit for Washington state. Put Washington AFFIDAVIT for newborn in the subject line.
Here is the text below...

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


AFFIDAVIT

I/We, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being(s), state Citizen(s) of the Washington Republic affirm: Be it known to all courts, governments, and other parties that:

Being (a person/people) of Strong Christian Morals, it is against (my/our) Deep, Sincerely Held, Religious Convictions to accept the injection of any foreign substance into (my Body/our Bodies) or the Body of (my/our) Child. This includes, but is not limited to, any and all, Vaccinations, Shots, Tests for Diseases, Oral Vaccines, Epidermal Patches and in any other way that Live or Killed Bacterium, Viruses, Pathogens, Germs, or any other Microorganisms, may be introduced into or upon (my/our) newborn's body.

This written statement to exempt (my/our) newborn from any immunizations, newborn screening, and the Vitamin K shot, because (Iwe) hold genuine and sincere personal religious beliefs which are inconsistent with these medical procedures & experimentation. The practice of vaccination and the injection or application of any foreign substance is contrary to (my/our) conscientiously held religious beliefs and practices, and violates the free exercise of (my/our) religious principles.

The Hepatitis-B vaccine supposedly protects against a disease that is only transmitted through multiple sexual partners or street IV drug users and therefore usurps (my/our) parental authority to condemn such activity in (my/our) child. The acceptance of this vaccine promotes sexual promiscuity and immoral behavior in direct contradiction to the teachings of (my/our) faith.

The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert.
http://www.fda.gov/medwatch/SAFETY/2003/03Feb_PI/AquaMEPHYTON_PI.pdf
"WARNING - INTRAVENOUS USE Severe reactions, including fatalities, have occurred during and immediately after the parenteral administration of AquaMEPHYTON® (Phytonadione)."
A conflict arises because (my/our) religious convictions are predicated on the belief that all life is sacred. God's commandment "Thou Shall Not Kill" applies to the practice of injection of carcinogenic substances that can kill.

(We / I) {First and Last name(s)}, as the {(parent (s) /guardian(s)} of (name of newborn child) are exercising (our/my) rights under the First Amendment of the US Constitution, RCW 70.83.020 and RCW 28A.210.090 to receive Religious Exemption from Vaccination, ALL injections, & testing.

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

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

The Lord Jesus Christ and Our Creator are the only source of protection of (my body/our bodies) and that of (my/our) family that (I/we) can accept.

(I/We) affirm that vaccination & injections of any foreign substances and proteins conflict with (my/our) religious beliefs as stated above. Therefore, (I/we) would request that you accommodate (my/our) religious beliefs and practices by exempting (my/our) newborn child from any vaccinations, injections and testing of any kind.

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

Further Affiant Saith Not

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

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


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


_______________________________
Signature of Affiant

      ACKNOWLEDGMENT

state of Washington

county of _________________:

On this _______ day of ______________, 200__, before me

personally appeared __________________________________, to me known to be the person described in and who executed the foregoing instrument and acknowledged that he executed the same as his free act and deed, for the purposes therein set forth.


       _______________________________________
      (Notary Public)

My Commission Expires ______________________________, 200___

The above AFFIDAVIT is available in Microsoft Word (.doc) and WordPerfect (.wpd) format.
Click here to Contact Donna.

Birth Certificate and Marriage License Opt-Out:

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

Postnatal - 2 months (first "well baby" visit):

If you do take your new baby to an MD as opposed to a naturopath and/or chiropractor, please be aware and careful of any forms you sign.

We're referring to those "Refusal To Vaccinate" forms put out by the American Academy of Pediatrics. Go to this page below and find out why signing this form is very dangerous. We all know about these forms and how they can be used to undermine parental rights...
http://www.vaclib.org/legal/donotsign.htm

"By endorsing this particular waiver, parents would essentially be signing an admittance of neglect and or "abuse" for refusing vaccines. The language contained in this waiver could put parents and caregivers in jeopardy down-the-line if they should ever find themselves in the courts due to their child's health problems, when confronted with child protective services, divorce, or just about any matter pertaining to that child that could be used against the parent(s).

Please read any waiver provided by your child's doctor carefully before signing. Instead, offer a formally written and signed letter that simply says that you do not wish to vaccinate your child. If you are unsure of the language in the waiver, buy some time by telling your doctor that you need to consult with a lawyer before signing it. "


Anai Rhoads Ford
Human Rights Journalist
Why Signing a Waiver to Avoid Vaccines Can Be Considered Abuse by Anai Rhoads Ford, released 15 November 2005.
http://www.anairhoads.org/

Media Contact (703) 491-1903


Generic Vaccine Refusal Form from Dr. Sherri Tenpenny's webpage.
(.pdf) http://www.nmaseminars.com/files/Vaccine_Refusal_Form.pdf
(.doc) http://www.nmaseminars.com/files/SampleVaccineExemptionForm.doc

State Form Required: No. However, the Washington Certificate of Immunization Cis06 immunization form can be used.   It also has an exemption section on back of form that is checked and signed.

Daycare & Preschools:

Washington State
SUPERINTENDENT OF PUBLIC INSTRUCTION
Sample Scoliosis Exemption Form page 10 of pdf document
http://www.ncesd.org/migranthealth/docs/healthmanual/Scoliosis.pdf

Schools:

The Washington Certificate of Immunization Status cis99 (now renamed Cis04) immunization form can be used, or use the exemption form below.
ExemptionVacLib-Washington.doc (11439)

Anacortes School District
Anacortes, WA 98221
Exemption Form page 9
(.pdf) http://www.asd103.org/registration/ams/packet.pdf

Seattle Schools
(.pdf) http://www.seattleschools.org/area/healthservices/forms/cis04.pdf

Evergreen Public Schools
Statement of Exemption to Immunization Law (page 2)
(.pdf) http://www.egreen.wednet.edu/pdfs/cis99.pdf

Puget Sound Educational Service District
(.pdf) Certificate of Immunization Status & Immunization Entry Requirements: English, Spanish
(Includes Statement of Exemption to Immunization Law)

Washington State Certificate of Immunization Status Forms:
FOR ALL SCHOOLS
Statement of Exemption to Immunization Law on the back of the forms.
Check and sign, and you have the exemption!
Available in all these languages! Wow!

The forms page is here:

English
(.pdf) http://www.doh.wa.gov/cfh/immunize/documents/Cis06.pdf

English Certificate of Immunization Status Overlay transparency
(.pdf) http://www.doh.wa.gov/cfh/Immunize/documents/cis06overlay.pdf

Spanish
(.pdf) http://www.doh.wa.gov/cfh/Immunize/documents/cis06sp.pdf

French
(.pdf) http://www.doh.wa.gov/cfh/Immunize/documents/cisfrench.pdf

Albanian
(.pdf) http://www.doh.wa.gov/cfh/Immunize/documents/cisalbanian.pdf

Amharic
(.pdf) http://www.doh.wa.gov/cfh/immunize/documents/17cisamha.pdf
Additional Web Archives links (Amharic):
(.pdf) http://www.doh.wa.gov/cfh/immunize/documents/17cisamha.pdf
(.pdf) http://www.doh.wa.gov/cfh/immunize/documents/17cisamha.pdf
(.pdf) http://www.doh.wa.gov/cfh/immunize/documents/17cisamha.pdf

Arabic
(.pdf) http://www.doh.wa.gov/cfh/Immunize/documents/cisarabic.pdf

Punjabi
(.pdf) http://www.doh.wa.gov/cfh/Immunize/documents/cispunjabi.pdf

Bosnian
(.pdf) http://www.doh.wa.gov/cfh/Immunize/documents/cisbosnian.pdf

Russian
(.pdf) http://www.doh.wa.gov/cfh/Immunize/documents/cisrussian.pdf

Cambodian
(.pdf) http://www.doh.wa.gov/cfh/Immunize/documents/ciscambodian.pdf

Somali
(.pdf) http://www.doh.wa.gov/cfh/Immunize/documents/cissomali.pdf

Chinese
(.pdf) http://www.doh.wa.gov/cfh/Immunize/documents/cischinese.pdf

Tagalog
(.pdf) http://www.doh.wa.gov/cfh/Immunize/documents/cistagalog.pdf

Haitian Creole
(.pdf) http://www.doh.wa.gov/cfh/Immunize/documents/cishaitiancreole.pdf

Thai
(.pdf) http://www.doh.wa.gov/cfh/Immunize/documents/cisthai.pdf

Hmong
(.pdf) http://www.doh.wa.gov/cfh/Immunize/documents/cishmong.pdf

Tigrigna
(.pdf) http://www.doh.wa.gov/cfh/immunize/documents/13cistigr.pdf
Additional Web Archives links (Tigrigna):
(.pdf) http://www.doh.wa.gov/cfh/immunize/documents/13cistigr.pdf
(.pdf) http://www.doh.wa.gov/cfh/immunize/documents/13cistigr.pdf
(.pdf) http://www.doh.wa.gov/cfh/immunize/documents/13cistigr.pdf
(.pdf) http://www.doh.wa.gov/cfh/immunize/documents/13cistigr.pdf

Japanese
(.pdf) http://www.doh.wa.gov/cfh/Immunize/documents/cisjapanese.pdf

Urdu
(.pdf) http://www.doh.wa.gov/cfh/Immunize/documents/cisurdu.pdf

Korean
(.pdf) http://www.doh.wa.gov/cfh/Immunize/documents/ciskorean.pdf

Vietnamese
(.pdf) http://www.doh.wa.gov/cfh/Immunize/documents/cisvietnamese.pdf

Portuguese
(.pdf) http://www.doh.wa.gov/cfh/Immunize/documents/cisportuguese.pdf

Laotian
(.pdf) http://www.doh.wa.gov/cfh/Immunize/documents/cislao.pdf

These forms are from this website below...
http://www.doh.wa.gov/cfh/Immunize/formpubs.htm

Opt-Outs:

Military Recruiters:

STUDENT OPT OUT FORM regarding the
RELEASE OF NAME, ADDRESS, AND TELEPHONE NUMBER TO MILITARY RECRUITERS
(.pdf) http://www.militaryfreeschools.org/PDF/optout2.pdf

UNDERGROUND ACTION ALLIANCE STUDENT OPT OUT FORM
(.pdf) http://www.militaryfreezone.org/opt_out.pdf
(.doc) http://veterans4peace.org/opt_out.doc

SAMPLE ENGLISH - BINGUAL FORMS FOR OPTING OUT
Act to Protect Your Privacy from Military Recruiters
(.pdf) http://www.afsc.org/pacificsw/documents/Opt-Out-Form.pdf

STUDENT OPT-OUT - Google Search

STUDENT OPT-OUT NOTICE regarding the instruction of sexuality to children:
STUDENT OPT-OUT NOTICE Valid in all 50 states
(.pdf) http://www.ccv.org/images/StudentOptOutNotice.PDF
(.pdf) http://www.catholiccitizens.org/content/img/f26422/opt%20out%20notice.pdf
(.html) http://www.ccv.org/images/StudentOptOutNotice.htm
Entire packet...
(.doc) http://www.mfc.org/respect/Website/Links%20on%20Web%20Page/Opt-Out%20Packet.doc

STUDENT OPT-OUT NOTICE - Google Search

Colleges:

WESTERN WASHINGTON UNIVERSITY
(.pdf)
Measles Immunization Policy
(.pdf) Measles Immunity Waiver
(.html) Measles Immunity Waiver
(.html) Measles Immunity Waiver
SUMMER QUARTER ONLY STUDENT
Request for a WAIVER from the Measles Immunity Registration Requirement
(.pdf) Measles Immunity Waiver (Summer Quarter)
See Measles scare forces Western to cancel waiver
Be prepared to get legal help if they deny the waiver. Use THE ACCEPTANCE OF RESPONSIBILITY FORM This form is imperative in exercising your rights for legal exemptions from forced medical experimentation and legalized bioterrorism. DO be prepared to fight for the right to own your body and to obtain a college education.

Evergreen State College - Olympia, Washington
Measles Immunization Waiver on page 2. Looks like this:
WAIVER
Due to medical, religious, personal or other reasons I choose to decline immunization. In the event of a Measles outbreak on campus, I agree to comply with quarantine or isolation procedures as recommeded by the Center for Disease Control and the local Public Health Department. I understand that this will likely result in missing classes or any other campus activity, including student employment, for the duration of exposure risk.
STUDENT SIGNATURE_________________________________ DATE:_______________
(.pdf) http://www.evergreen.edu/health/docs/mmrrec1.pdf

University of Washington
Waiver Applications for the Practicum MPH Immunization Waiver Application
(.pdf) http://depts.washington.edu/hsedp/admitstu/1styr/waivers.pdf

These Google searches are mostly the college and school exemptions. There are always new forms coming online. Keep a regular check on these to look for newly added forms. Some are for daycare too. The links are the actual keywords that are used.

Immunization Exemption Form

Vaccine Exemption Form

Immunization Waiver

Employment:

Washington State OSHA Hepatitis B Vaccine Declination Form.
Use with Chapter 296-823 WAC, Occupational Exposure to Bloodborne Pathogens

(.pdf) Adobe PDF
(.doc) Microsoft Word

The above two documents are from this page...
HT5 Hepatits B Vaccine Declination Form

City of Spokane Forms...
(.doc) (Word) The City of Spokane Hepatitis B Vaccine Declination Form. Page 2
(.pdf) (Adobe PDF) The City of Spokane Hepatitis B Vaccine Declination Form. Page 2
Written Bloodborne Pathogen Exposure Control Plan For the City of Spokane
Hepatitis B Vaccine Declination Form Page 14
(.doc) (Word) http://www.spokanerisk.org/Risk%20Files/Writtenbloodpathexposcntrlplan%202005.doc

City of Spokane Hepatitis B Vaccine Declination Form with LIST OF EMPLOYEE CLASSIFICATIONS WITH OCCUPATIONAL EXPOSURE TO BLOODBORNE PATHOGENS
APPENDIX FC2B
(.doc) (Word) HEPATITIS B VACCINATION DECLINATION FORM. Page 3
The above Word forms are available in PDF format. Email us if you want them in Adobe PDF.

Generic Hepatitis B Vaccine Statement:
http://www.nmaseminars.com/files/HepatitisBDeclinationStatement.doc

MEMBER REFUSAL OF IMMUNIZATIONS IN EMPLOYMENT SETTING
HTML http://www.nwreligiousliberty.org/sample%20letters/sda_wa_work_immuniz.htm
This is for Seventh Day Adventists
Microsoft Word Document of above letter...
Microsoft Word Document (.doc) VaccineTruth.net/letters/WashingtonReligiousexemption.doc

AFFIDAVIT for Washington Adult
(college/employment religious exemption)
... Edit as needed...


AFFIDAVIT

I, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being, state Citizen of the Washington Republic affirm: Be it known to all courts, governments, and other parties that:

Being a person of Strong Christian Morals, it is against my Deep, Sincerely Held, Religious Convictions to accept the injection of any foreign substance into my Body. This includes, but is not limited to, any and all, Vaccinations, Shots, Tests for Diseases, Oral Vaccines, Epidermal Patches and in any other way that Live or Killed Bacterium, Viruses, Pathogens, Germs, or any other Microorganisms, may be introduced into or upon my body.

This written statement to exempt myself from any immunizations, Mantoux (PPD) Tuberculin Test, 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. The acceptance of this vaccine promotes sexual promiscuity and immoral behavior in direct contradiction to the teachings of my faith.

I, {First and Last name}, am exercising my rights under the First Amendment of the US Constitution and Washington State Constitution, Article I, Section 11, Religious Freedom to receive Religious Exemption from Vaccination & testing.

Applicable law has been interpreted to mean that a religious belief is subject to protection even though no religious group espouses such beliefs or the fact that the religious group to which the individual professes to belong may not advocate or require such belief. Title VII of the Civil Rights Act of 1964 as amended Nov. 1, 1980; Part 1605.1-Guidelines on Discrimination Because of Religion. The Washington State Constitution, Article I, Section 11, Religious Freedom says, ""Absolute freedom of conscience in all matters of religious sentiment, belief and worship, shall be guaranteed to every individual...""

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

I affirm that vaccination & injections of foreign proteins conflict with my religious belief as stated above. Therefore, I would request that you accommodate my religious beliefs and practices by exempting me from the college vaccination and TB testing requirement.

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

Further Affiant Saith Not

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

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


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


_______________________________
Signature of Affiant

      ACKNOWLEDGMENT

state of Washington

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___

Microsoft Word Document of above AFFIDAVIT...
(.doc) VaccineTruth.net/letters/AFFIDAVITforWashingtonAdult.doc

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
or
Hep B vaccine waiver

Fight SpamBots!

TB Test:

TB Testing Exemption Letter:
HTML
Sample Exemption Letter for TB testing. May be modified to your use. http://www.vaclib.org/letters/TBwaiverGen.htm
Microsoft Word Document (.doc)
Sample Exemption Letter for TB testing. May be modified to your use. http://www.vaclib.org/letters/TBwaiverGen.doc

TB Testing Exemption Letter for Adults:
Microsoft Word Document (.doc)
Sample Exemption Letter for TB testing. May be modified to your use. http://www.vaclib.org/letters/TBTestingWaiverAdult.doc
WordPerfect Document (.wpd)
Sample Exemption Letter for TB testing. May be modified to your use. http://www.vaclib.org/letters/TBTestingWaiverAdult.wpd
PDF document (.pdf)
Sample Exemption Letter for TB testing. http://www.vaclib.org/letters/TBTestingWaiverAdult.pdf
Extra link from Dr. Sheri Tenpenny's webpage:
(.pdf) http://www.nmaseminars.com/files/Exemption_for_TB_testing_1_.pdf

Lead Testing Exemption Letter:
HTML
Sample Exemption Letter for Lead testing. May be modified to your use. http://www.vaclib.org/letters/Lead_testing_waiverGen.htm
Microsoft Word Document (.doc)
Sample Exemption Letter for Lead testing. May be modified to your use. http://www.vaclib.org/letters/Lead_testing_waiverGen.doc

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


TB Testing Alternatives...

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

Here are some of the practitioners for Washington state

Washington state BEST™ BioMeridian Practitioners:

Natural Health Technologies Clinic
1215 Regents Blvd, Suite D1
Tacoma, WA 98465
Phone: (253) 564-9223
E-Mail: awparr1914@earthlink.net
http://www.mynht.com
Also has F-Scan available. See under F Scan practitioners below.

Seattle Balanced Body
Katherine Branigan
7216 Fourth AVE NW
Seattle, WA
(206) 781-7167
Please come around to the back entrance.
http://www.seattlebalancedbody.com
kbranigan@seattlebalancedbody.com
help@seattlebalancedbody.com
BioMeridian Electrodermal Screening (EDS):
Here is a meridian stress assessment system that allows us an energetic look at your body systems. It operates on the basis of evaluating energetic health by accessing electronic resistance measurements through the clients Acupoints, which correlate to body organs and functions according to Chinese meridian theory. It is approved by the FDA under the 510-k listing. It has a unique feature of also being able to show what the body's energetic response is to medications and supplements.

Washington state QXCI Practitioners:

Accelerated Recovery Health Center
Vancouver, Wa 98665-6308
360-573-5923

D-Light Modulations
Carol Drury
Friday Harbour,Wa 28250
360-378-2626

Deanne Eakin
EPFX / QXCI Biofeedback Practitioner, Energetics Counsler
Energetics Awareness and Hebal Nutrion
Fees: $65-$85 per hour Depending on your location
Appointments by phone and in person
Seattle, Puget Sound, WA
425-313-0639
206-353-0295(cell)

Dr. Robert Erdmann, PHD
Certified Clinical Nutrionist
2398 Alaska Ave.
Port Orchard, WA 98366
360-871-1234
berdman@charter.net
Web Address:www.bioscienceproducts.com

Linda Melos ND
Naturopathic Medicine
Combining EPFX / QXCI with Kinesiology, Naet
Sequim, WA 98382
360-681-0886
lindamelos@juno.com

Janet Zibell
EPFX / QXCI Practioner
Olympia, WA
360-459-9306
zibelle@olywa.net

http://www.theqxci.com/practitioners.php#NorthWest

Gayla Erickson
Certified Biofeedback Therapist, SCIO/QXCI Practitioner, LIFE device therapist
Service Areas:
I travel Washington, plus parts of the surrounding states, i.e. Idaho, Montana, Oregon - USA - if ones can arrange enough clients for the trip
Specialties:
Getting you in contact with the modality that would work the best for you. I have learned about the latest and greatest devices from other countries from therapists who actually use the equipment, instead of from a salesman.
Helping people get off of alcohol, cigarettes, chewing tobacco.
#1 Pain relief
Detox
Fees:
SCIO/QXCI $100/hr for a 2 hr therapy
L.I.F.E. device $100/hr for a 2 hr therapy
SCENAR $65-85 for a pain-relief therapy
Q2 therapy-35 min for $35 or 10 therapies prepaid $250
Chi therapy $10-15
Far Infrared therapy $20 30 min, $30 1 hour
Electro Reflex Energizer $20 30 min, $30 1 hour
Cedar sauna infrared- watch TV while losing weight $15 for up to 1 hr
Steamy Wonder- steam-generated Himalayan Crystal Salt detox $30 for 20-30 min
GX-99- cellulite reducer, machine massage $45 for 30-45 min
Parasite zap- $40
Spinalator chiropractic lift-and-stretch roller table therapy $15
Zero gravity chair w/ heat & massage $5-10
Come visit us in our new location:
Revitalize! Health Spa & Organic Store
311 W Kennewick Ave
Kennewick, WA 99336
www.BiofeedbackPlus1.com
Email: gaylafe@aol.com
Office: (509) 586-6574

Main page of practitioners:
http://www.theqxci.com/information.php

Washington state F-Scan Practitioners

Adrian Parr, CNT
1510 Brookside Terrace
Tacoma, WA. 98465
P +1-253-564-9223
www.mynht.com
If you want to educate and empower yourself to heal your family or love ones we have what you need. We have available the F-Scan and the EAV which have the frequencies of all the parasites, virus, mold, fungi, toxins, solvents and bacteria listed in Dr. Clark's 'Cure of all Diseases'.

Mari Fleetwood
Olympia, Washington
lymar@orcalink.com

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 1-888-249-1421.



Immunization Registry Opt-Out:

What if I do not wish to participate?

If you do not want to receive CHILD Profile mailings, call Healthy Mothers, Healthy Babies at 1-800-322-2588.If you do not wish to have your child's immunizations entered into the registry, talk with your doctor or nurse. If they use the CHILD Profile Immunization Registry, they can take steps to honor your request.

You may also contact the CHILD Profile office:
999 Third Ave., Suite 900
Seattle, WA 98104
206-205-4141 or 1-800-325-5599
Advanced Scientific Health

Vaccination Liberation - Idaho Chapter
Contact: Vaccination Liberation

"Free Your Mind....From The Vaccine Paradigm"
www.vaclib.org

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