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Do_Not_Sign   |     Signing_Under_Duress

Do Not Sign
AAP or other self-incriminating Vaccine Refusal forms

Basically, some doctors are giving patients who choose not to vaccinate their children a form to sign created by the American Academy of Pediatrics (AAP). This form varies somewhat from state to state but basically it is a total propaganda sheet about the alleged value of vaccines, the alleged "risk" of not vaccinating and, even worse, the parent who signs the form is falsely "admitting" that they are putting their children at risk.

Lower on this page we have a letter from our director that explains more about why self-incriminating forms are to be avoided.

    When faced with a request to sign a form which removes liability from your doctor, you have several options:

  • Change doctors to a holistic physician such as a naturopath, homeopath or other medical provider who does not require you to remove the liability from their shoulders in the event your child becomes sick.

  • Write your own form letter.

  • Use our form 'as is' or modify it to reflect your needs.

  • WARNING/DISCLAIMER: Please note that the law varies from state to state. Thus we HAVE NOT asked the advice of a lawyer about what unforeseen consequences might arise from using this form.
    If you do consult a lawyer in your state about using our form, please share with us the comments you receive. Thanks.
    RefuseVaccines1.doc [MS Word 25K]
    RefuseVaccines1.pdf [Adobe PDF 87K]
    Note: the intention of this above form is
    • To give the doctor release from liability in case your child acquires what allegedly is a 'Vaccine Preventable Disease'.
    • To avoid the creation of liability for yourself.
    • To give the doctor a little bit of information to make them think.
    • To put 'concerned parties' on notice that you have done your homework.

The form above avoids telling the doctor why you choose not to vaccinate. Your reason for not vaccinating is your affair, unless you choose to divulge it. For example, you might want the doctor to know that your religion forbids certain treatments.
  • Re-write the given form and cross out key words which will change the document's meaning: I.E.
  • "I am aware of the risks of not vaccinating my child. [cross out the word "not"]
    Examples of a re-written form: Mod_ARvax2.doc  |   Mod_ARvax2.pdf  |   AAPmodified_forms

    Further questions about exemptions:
    If you need to email us ( about exemptions or exemption forms, Click here:

    If you wish to give your doctor a letter of explanation containing more facts than those listed in "RefuseVaccines", then consider using the letter here, Letter-to-doctor.doc


To ALL who choose to partially vaccinate or NOT vaccinate their children:

We (here in Idaho) are hearing more reports of schools and daycares across our state not honoring legal and valid vaccine exemptions. The following article contains very important information as to why you do NOT want to sign AAP's (state adopted) exemption form:

Filing a Vaccination Notice:

Filing a Vaccination Notice with Instructions.pdf - (

Older letter regarding exemptions in Idaho (similar to many states today)

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.

For more background on the problem of self-incriminating Vaccine Refusal forms see this offsite page:

Links to information about T.D.C./TDC
Threat Duress Coercion
The following excerpts were found on the internet. One rule of thumb is that any restrictions on your 'signature' must be prior to, or before you sign/autograph the document.
Signing Under Duress
Say "Under Duress I will comply with your demand." And then autograph the document:

Under Duress, Threat, and Coercion (or “under TDC”, for short)
(your autograph)
Print Name         See more at archived source:

Signature Under Duress
If one of the parties can prove that the contract was signed under duress, that is, the party's signature was extracted by physical or mental coercion, then the contract is null and void.

Duress is defined as coercion of a party to execute a contract against the free will of that party. For example, a person signs a check, or a deed transferring a house title to a stranger, under a threat or act of violence, imprisonment (retaining a person in a confined space), victim's property detention or breach of contract. Article is archived here:

How to Prove that Documents Were Signed Under Duress
Duress is one of the most vague areas of U.S. law, and also one of the simplest. Essentially, duress is the act of forcing another person or party to do something against his or her will, usually with a threat of violence or other harm. Many times, agreements and contracts are signed under duress but there is no proof, or else the victim doesn't realize that he or she can contest the validity of the signed document. But how do you prove that documents were signed under duress?

Is the contract fair and equitable?
A contract - of any sort - should be a fair and equitable "meeting of the minds", which means that it benefits both parties equally. If a contract is biased toward the other party, you will have an easier time proving that you wouldn't have signed it in normal circumstances. Explain that the documents were signed under duress, and that you don't find a meeting of the minds anywhere in the contract.

Is there a history of hostility between the two parties?
It is also easier to prove that documents were signed under duress if you and the other party have a history of arguing, fighting or disagreeing. A court is more likely to believe that you didn't sign a contract of your free will if it is unlikely that you would enter into an agreement with the other party in the first place. But you'll need to provide evidence of past disagreements, such as testimony from eyewitnesses or proof of letters or phone calls.

Did someone see you sign the papers?
A witness is an invaluable asset when trying to prove that documents were signed under duress. Chances are, if someone witnessed the signing of the contract, he or she also witnessed the pressure - either physical or otherwise - administered to get you to sign. Perhaps the witness heard verbal threats or was privy to a physical beating that ultimately convinced you to sign the papers. Whatever the case, the witness will need to testify.

Read rest of article archived here:

Signing in protest and under duress
V.C., initial and circle. Also the ellipse (...)
Vi Coactus
Before you sign anything under duress, in order not to be unfairly determined as in dishonor and incompetent, you may lawfully initial in large letters the letters V.C. where you will sign, then sign your name after- always after. What V.C. stands for is Latin for Vi Coactus which means literally "under constraint". This should normally be sufficient on any document which you are forced to sign to bear witness to the fact that it was done under duress.

The use of ellipse
When the treat of intimidation or outright rejection of lawful protest is too great, then a second and equally valid method of signing under protest is permitted, namely the use of three full stops placed first, followed by the signature so that the three dots are not obscured by the signature. This is called an ellipse eg "..." and indicates that legally there was a form of words you wanted to state but were unable due to some event, in this case because of threat and coercion. Thus, at the earliest opportunity the ellipse can be revealed and it can be stated that you intended to write V.C. but were prevented therefore nullifying any agreement. More:

Helpful article on reserving your rights under the UCC

Vaccination Liberation - Idaho Chapter
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