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      ` &Smallpox0 h 0h%h%&Anthrax#??݌ @%% Ќ&o &   XXXXXX   #  E1XX` hp x (#XXXE& &o  #@  #@cA݌̌&o &   XXXXXX   #  E1XX` hp x (#XXXE& &o  #A  Thisispursuanttomyrighttorefusevaccinationonthegroundsthatvaccinationsconflictwith "h  myreligiousbeliefs.PursuanttoHawaiistatuteIamprovidingacopyofthisstatementtoour #|!! childsschooladministratororoperatorofthegroupprogrampursuantto#AB݌ $"" Ќ&o &   XXXXXX     #  E1XX` hp x (#XXXE& &o  #D  HawaiiAdministrativeRules111575andHaw.Rev.Stat.32534.#D#E݌ %## Ќ&o &   XXXXXX     #  E1XX` hp x (#XXXE& &o  #)F  #)FF݌̌&o &   XXXXXX     #o&o0#&oo"  E1XX` hp x (#XXXE&o&o%&o  "G  #o%G# o&  #&o &ޥH#& &oParent__________________________________Date_______________"GcH݌ $(%% Ќ&o &&o&o   XXXXXX     "  E1XX` hp x (#XXXE&o&o%&o  "J  #%%I#%J %# %J H#&  "JJ݌̌&o &&o&o   XXXXXX   "  E1XX` hp x (#XXXE&o&o%&o  "L  #%%K##o%[K#&oo& &oParent__________________________________Date_______________"LL݌ L*'' Ќ&o &&o&o   XXXXXX   "  E1XX` hp x (#XXXE&o&o%&o  "^N  #%%QM#%J %# %J 2M#&  "^NO݌̌&o &&o&o   XXXXXX   "  E1XX` hp x (#XXXE&o&o%&o  "TP  #%%XO##o%O#&oo& &oSubscribedandSwornbeforemethis_____dayof___________,20____.#&o &ސQ#& &o#  &qQ#&  "TP Q݌ t,*) Ќ&o &&o&o   XXXXXX   "  E1XX` hp x (#XXXE&o&o%&o  "'S  #%%R#%J %# %J YR#&  "'SS݌̌&o &&o&o   XXXXXX   "  E1XX` hp x (#XXXE&o&o%&o  "U  #%%!T##o%cT#&oo& &o________________________________________"UU݌ .D,+ Ќ&o &&o&o   XXXXXX   "  E1XX` hp x (#XXXE&o&o%&o  "PW  #%%YV##o%:V#&oo& &oNotary'sSignatureandSeal"PWX݌ /X-, Ќ&o &&o&o   XXXXXX     #&o&oX##o&omX#XKXo #oXXKY#&Q%o&&Q%%&Q#&o%&&Q Z#&&Q%&oMakingInformedDecisions 4 _ #&o%&&QnZ##o&o,Z#&oo&&Q%&o_ԀYourdecisiontovaccinateornotshouldbeaninformeddecision.Vaccinescancausesevereinjuriessuchasseizures,  death,anaphylaxis,braindamageandotherreactions.Thetypeandseverityofreactionsmayvaryfromvaccinetovaccine  andchildtochild.Theeffectsofavaccineinjurymaybetemporaryorpermanent.Ifyounoticeanychangesinyourchild#&o%&&Q4[#&&Q%&os p conditionafterreceivingavaccine,youshouldcontactyourdoctorimmediatelyorgotoahospital.Vaccineshavenever L beenproventobesafeoreffectiveandyourchildmaycontractthediseaseevenifheisvaccinated.Whathasbeenprovenis ( thatyoucangetthediseasefromthevaccineorfromcomingintocontactwitharecentlyvaccinatedperson.Thepolio \ vaccineisjustoneexample.Itisaknownfactthatmosthealthcareprovidersdonotfullyinformpatientsofthesideeffects 8  avaccinecanhaveonthebody,brainandimmunesystem.Becauseofthehighlytoxicingredientsallvaccinescontain,you    shouldthoroughlyresearchvaccinesforyourselfbeforemakingsuchanimportantdecision.DONOTallowsomeoneelse,    evenyourhealthcareprovider,scareorforceyouintomakingthisdecisionwithoutbeingfullyinformed.Manyhealthcare  t  providershavenotresearchedvaccinehistoryortoxicologyandarenotfullyinformed.  P    #&o%&&Q]#&&Q%&oԀAlwaysprovideadetailedhistoryofyourchild#&o%&&Qa#&&Q%&oshealthtoyourdoctor.Makesuretheyknowofallergies,  ,  neurologicalproblems,nutritionaldeficiencies,anyimmunesystemdisorderandskindiseasessuchaseczema.Most `  physiciansandnursesdonotwarnparentsthatiftheirchild#&o%&&QTb#&&Q%&oshealthiscompromisedinanyway,suchashavingacommon <  coldorpreviousreactiontoavaccine,theyshouldnotreceivevaccines.     _#&o%&&Qc##o&o[#&  _   E1XX` hp x (#XXXE XKXo     d  _&XKXXXK&&Q%X&XKBenefits_ԀofNon#&XKX%&&Qe#&&Q%X&XKVaccination de eԌ x Ќ&o%&&Q    XXXXXX   _#&XKX&oWf##XKXX&XKe#&XKXXXK&&Q%X&XK_ԀWhenyouchoosetonotvaccinateyourchild,youhavetheresponsibilitytoeducateyourselfonhowtomaintainthe T well#&XKX%&&Qg#&&Q%X&XKbeingofnotonlytheirbodybutalsotheirmindandspiritaswell.Childhooddiseasescanresultinminorsymptomsto 0 severecomplicationordeathdependingonthechild#&XKX%&&Qh#&&Q%X&XKsimmunesystemandtreatmentprotocolsfollowed.Thestrongerthe d  immunesystem,thelessseverearethesymptomsofthedisease.Achildthatgoesthroughthefullexpressionofthedisease @ (i.e.feverandskineruptions,withoutsuppressinganyofthesesymptoms)usuallyacquiresimmunityfromthatdiseasefor  life.Goodnutritionandcleanlinessplayamajorrole.Theriskofcontractingvariousdiseasescanvaryovertimeor  locality.Symptomsorcomplicationsofthesediseasesmaybetreatablebyalternativemethodsormayresolvewithout | treatment.Educateyourselfonchildhooddiseasesfrominformedalternativesources.Fearofthesediseasescomesfromnot X beingproperlyinformed.'d 4     #&XKX%&&Qi##XKXX&XK}g#oXXK& (    E1XX` hp x (#XXXE XKXo     m  _#XKXXXK^m#&XKXXXK&&Q%X&XKFor_ԀMoreInformation m2n nԌ D Ќ&o%&&Q    XXXXXX   #&XKX&on##XKXX&XKn#oXXK#  E1XX` hp x (#XXXE o  #o  _#XKX o#&XKXXXK&&Q%X&XK_ԀTomakeatrulyinformeddecisiontherearenumeroussourcesofinformationontherisksofvaccinesandtherisksand   benefitsofchildhooddiseases.Sourcesofinformationtodetermineiftherisksassociatedwithvaccinesoutweighany  perceivedbenefitsinclude:vaccinepackageinserts,thePhysiciansDeskReference,theU.S.CenterforDiseaseControland   Prevention,publicandmedicallibrariesorstateandlocalhealthagencies.(NOTE:Thesesourcesdonotgivecompleteand \! totalinformationonvaccineingredientsandtheirtoxicity,nordotheyprovideaccuratestatistics.)'(D}m#op݌ 8" Ќ&o%&&Q   XXXXXX   _#&XKX&op##XKXX&XKp#&XKXXXK&&Q%X&XKVaccination_ԀLiberation#&XKX%&&Qt#&&Q%X&XK!#&XKX%&&QJu##XKXX&XKt#4) (   5  __$  _&XKXXXK&&Q%X&XKwww.vaclib.org$#v0   #&XKX%&&Qv##XKXX&XKdv#&XKXXXK__6u(u0    7Tu#XKXX&XK##XKXX&XK#&XKXXXK&&Q%X&XK_ԀIfyoudodecidetovaccinate,reportvaccinereactionstotheVaccineAdverseEventReportingSystem(800)822#&XKX%&&Q#&&Q%X&XK7969. %D#) Alwaysgetthevaccinename,vaccinemanufacturerandlotnumber.Keeprecordsofdaytodayreactionsfromthetimeof x& $* vaccinationforatleast6monthsto2years,nomatterhowslightthereactions.Long#&XKX%&&Q`#&&Q%X&XKtermeffectsofvaccineshavenotbeen T'$+ welldocumentedbytheallopathiccommunityandarejustnowbeingresearched.Ifyourchildhasbeeninjuredbya 0(%, vaccine,hemaybeeligibleforcompensationundertheNationalVaccineInjuryCompensationProgram.'($  )&- #&XKX%&&Q##XKXX&XK|#  &Q%XXK&&Q%%&Q  #&XKX%&&Q^#&&Q%X&XKPage2of2 +H)0   #&XKX%&&Q͇##XKXX&XK}#  _&XKXXXK&&Q%X&XKRevised_Ԁ2/06#&XKX%&&Q#&&Q%X&XK  Source:VaccinationLiberation,P.O.Box457,SpiritLake,ID83869 X-+2 #&XKX%&&Q##XKXX&XK{#&XKXXXK  6" hp x (#XXX6ӀThisformmaybereproduced & X&XK#  &‰#&   4.+3   #&XKX &G##XKXX&XK#z