VACCINATION EXEMPTION FORM PURSUANT TO IDAHO STATUTE I.C. § 39-4804
I,____________________________, as the parent, guardian or person in
◻ Diphtheria ◻ Tetanus ◻ Pertussis ◻ Polio
◻ Measles ◻ Mumps ◻ Rubella ◻ Varicella
◻ Influenza ◻ Meningococcal ◻ Pneumococcal ◻ Rotavirus
◻ Hepatitis B ◻ Hepatitis A ◻ Haemophilus influenzae type b
◻ Human Papillomavirus ◻ Other_________
This is pursuant to my right to refuse vaccination on the statutory grounds of “other grounds”. This statement is for my child's files and can be shown to the school administrator or operator of the group program pursuant to I.C. § 39-4804.
Date: ____________________ __________________________
Reference:
TITLE 39 HEALTH AND SAFETY CHAPTER 48 IMMUNIZATION
39-4804. Notification
to parent or guardian. (1) Before an immunization is
administered to any child in this state, the parent or guardian of
the child shall be notified that:
(a) Immunizations
are not mandatory and may be refused on religious or other grounds;
(b) Participation
in the immunization registry is voluntary;
(c) The
parent or guardian is entitled to an accurate explanation of the
complications known to follow such immunization.
(2) At
the time information is initially collected regarding any child for
entry into the registry created pursuant to this chapter, the parent
or guardian shall be notified that:
(a) They
have the right under Idaho law to submit a statement pursuant to the
provisions of sections 39-1118 and 39-4802, Idaho Code, which exempts
them from any requirement to have information regarding the child
entered into the registry;
(b) At
any time they have the right to remove any information from the
registry regarding the child; and
(c) Immunizations
are not mandatory and may be refused on religious or other grounds.
(3) The
decision of a parent or guardian to:
(a) Submit
a statement pursuant to the provisions of either section 39-1118(2)
or 39-4802(2), Idaho Code;
(b) Remove
any information regarding the child from the registry pursuant to the
provisions of section 39-4803(4), Idaho Code; or
(c) Refuse
the immunization on religious or other grounds;
shall not be
used in any manner against the interests of the parent or guardian in
any administrative, civil or criminal action.
TITLE 39
HEALTH AND SAFETY CHAPTER 48 IMMUNIZATION
39-4802.Exemptions.
(1) Any minor child whose parent or guardian has submitted to school
officials a certificate signed by a physician licensed by the state
board of medicine stating that the physical condition of the child is
such that all or any of the required immunizations would endanger the
life or health of the child shall be exempt from the provisions of
this chapter.
(2) Any
minor child whose parent or guardian has submitted a signed
statement to school officials stating their objections on
religious or other grounds shall be exempt from the provisions
of this chapter.
The term “or other grounds” means that, as the parent and legal guardian, I have the right to choose whether or not to vaccinate my child. The statute does not require that I disclose what other grounds our refusal to immunization is. As with any medical decision, the decision to vaccinate or not is a right of the individual or parent. The state of Idaho, our doctor and public health employees cannot force my child to be vaccinated. My child cannot be excluded from a school or public program because we have exercised our right to not vaccinate.
Making
Informed Decisions
Your
decision to vaccinate or not should be an informed decision. Vaccines
can cause severe injuries such as seizures, death, anaphylaxis, brain
damage and other reactions. The type and severity of reactions may
vary from vaccine to vaccine and child to child. The effects of a
vaccine injury may be temporary or permanent. If you notice any
changes in your child’s condition after receiving a vaccine, you
should contact your doctor immediately or go to a hospital. Vaccines
have never been proven to be safe or effective and your child may
contract the disease even if he is vaccinated. What has been proven
is that you can get the disease from the vaccine or from coming into
contact with a recently vaccinated person. The polio vaccine is just
one example. It is a known fact that most healthcare providers do not
fully inform patients of the side effects a vaccine can have on the
body, brain and immune system. Because of the highly toxic
ingredients all vaccines contain, you should thoroughly research
vaccines for yourself before making such an important decision. DO
NOT allow someone else, even your healthcare provider, scare or force
you into making this decision without being fully informed. Many
healthcare providers have not researched vaccine history or
toxicology and are not fully informed.
Always provide a detailed history of your child’s health to your doctor. Make sure they know of allergies, neurological problems, nutritional deficiencies, any immune system disorder and skin diseases such as eczema. Most physicians and nurses do not warn parents that if their child’s health is compromised in any way, such as having a common cold or previous reaction to a vaccine, they should not receive vaccines.
Benefits of
Non-Vaccination
When
you choose to not vaccinate your child, you have the responsibility
to educate yourself on how to maintain the well-being of not only
their body but also their mind and spirit as well. Childhood diseases
can result in minor symptoms to severe complication or death
depending on the child’s immune system and treatment protocols
followed. The stronger the immune system, the less severe are the
symptoms of the disease. A child that goes through the full
expression of the disease (i.e. fever and skin eruptions, without
suppressing any of these symptoms) usually acquires immunity from
that disease for life. Good nutrition and cleanliness play a major
role. The risk of contracting various diseases can vary over time or
locality. Symptoms or complications of these diseases may be
treatable by alternative methods or may resolve without treatment.
Educate yourself on childhood diseases from informed alternative
sources. Fear of these diseases comes from not being properly
informed.
For More
Information
To make a
truly informed decision there are numerous sources of information on
the risks of vaccines and the risks and benefits of childhood
diseases. Sources of information to determine if the risks associated
with vaccines outweigh any perceived benefits include: vaccine
package inserts, the Physicians Desk Reference, the U.S. Center for
Disease Control and Prevention, public and medical libraries or state
and local health agencies. (NOTE: These sources do not give complete
and total information on vaccine ingredients and their toxicity, nor
do they provide accurate statistics.)
Vaccination Liberation – www.vaclib.org or (888) 249-1421
National Vaccine Information Center – http://www.nvic.org/ or (703) 938-0342
(NOTE: The two websites above, Vaccination Liberation and the National Vaccine Information Center, have proven to be excellent sources for extensive vaccine information.)
Reporting
Reactions
If you do
decide to vaccinate, report vaccine reactions to the Vaccine Adverse
Event Reporting System by going to
http://www.nvic.org/reportreaction.aspx. Always get the
vaccine name, vaccine manufacturer and lot number. Keep records of
day to day reactions from the time of vaccination for at least 6
months to 2 years, no matter how slight the reactions. Long-term
effects of vaccines have not been well documented by the allopathic
community and are just now being researched. If your child has been
injured by a vaccine, he may be eligible for compensation under the
National Vaccine Injury Compensation Program.
Revised 5/11 Source: Vaccination Liberation, P.O. Box 235, Hayden, ID 83835-0235 CopyRound ©