ARKANSAS - IMMUNIZATION EXEMPTIONS by State (includes current statutes, letters & forms)
IMMUNIZATION EXEMPTIONS by State (includes current statutes, letters & forms)Arkansas
Current Statutes & Laws: http://www.909shot.com/state-site/Arkansas.htm
Medical, Religious & Philosophical
Immunization requirements "shall not apply if the parents or legal guardian of that child object thereto on the grounds that immunization conflicts with the religious or philosophical beliefs of the parent or guardian." To obtain an exemption parents must sign a notarized statement requesting a religious, medical or philosophical exemption from the Department of Health (DOH). The parents must then complete an educational component prepared by the DOH, sign an informed consent with a refusal to vaccinate statement and a signed statement of understanding that the unimmunized child may be removed from school during an outbreak. This is a new law signed on April 1, 2003, the forms and education may still be in development but the law is enacted. For pertussis: if a child's sibling or half sibling had an adverse reaction the child is exempt.
PDF documents (.pdf)
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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. Ark. Stat. Ann. § 20-15-303
20-15-303. Exception.
The provisions of this subchapter shall not apply to any child whose parents or guardian objects thereto on the grounds that it conflicts with the tenets and practices of a recognized church or religious faith of which the parent or guardian is an adherent or member.
History. Acts 1967, No. 192, § 3; A.S.A. 1947, § 82-627.
http://www.arkleg.state.ar.us/NXT/gateway.dll?f=templates&fn=default.htm&vid=blr:code
http://www.ncsl.org/programs/health/screeningprivacy.htm
Hearing Screening...
ARKANSAS
Statute: Sec.5. No test is be performed if the parent of a newborn/infant dissents on the ground that the test conflicts with personal religious belief or practice. [Source: SB 819, 1999]
Rule: Sec.V. No test to be performed if the parent of a newborn/infant dissents on the ground that the test conflicts with personal religious belief pr practice. [Source: Arkansas Code Annotated 20-15-1501, 1999]
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.
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://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)."Alternatives to Vitamin K Prophylaxis...
fatalities=death
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.
Sample Vaccine Letters From this website... http://www.vaccines.bizland.com/letters.htm
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.
(.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.
Or you can do your own model birth plan letter online...
Hospital Birth Preference Plan ~ Birth Naturally, LLC
http://www.birthnaturally.org/GentleBirth/hospitalplan.htm
The birth plan arrangements and letter should be turned in before delievery date.
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 below AND model birth plan letter. I 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!
Birth plan religious AFFIDAVIT text below. Use with model birth plan letter and/or refusal forms, and edit as needed...
AFFIDAVIT is available in Microsoft Word (.doc) and WordPerfect (.wpd) format.
Contact us.
AFFIDAVIT
I/We, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being(s), state Citizen(s) of the Arkansas 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, SECTION 1. Arkansas Code Section 6-18-702(d)(4)(A) (4)(A), Ark. Stat. Ann. § 20-15-303 and, Statute: Sec.5 /Rule: Sec.V. 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 Arrkansas
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___
___________________________________________________________________________
Hearing Screening
Statute: Sec.5. No test is be performed if the parent of a newborn/infant dissents on the ground that the test conflicts with personal religious belief or practice. [Source: SB 819, 1999]
Rule: Sec.V. No test to be performed if the parent of a newborn/infant dissents on the ground that the test conflicts with personal religious belief pr practice. [Source: Arkansas Code Annotated 20-15-1501, 1999]
Religious Exemption from newborn screening
Ark. Stat. Ann. § 20-15-303 The provisions of this subchapter shall not apply to any child whose parents or guardian objects thereto on the grounds that it conflicts with the tenets and practices of a recognized church or religious faith of which the parent or guardian is an adherent or member. History. Acts 1967, No. 192, § 3; A.S.A. 1947, § 82-627.
Immunization Exemption
SECTION 1. Arkansas Code Section 6-18-702(d)(4)(A) (4)(A) The provisions of this section shall not apply if the parents or legal guardian of that child object thereto on the grounds that immunization conflicts with the religious tenets and practices of a recognized church or religious denomination of which OR PHILOSOPHICAL BELIEFS OF the parent or guardian is an adherent or member.
The above AFFIDAVIT is available in Microsoft Word
(.doc) and WordPerfect (.wpd) format.Click here to Contact Donna.
State Form Required: Yes.
To obtain an exemption parents must sign a notarized statement requesting a religious, medical or philosophical exemption from the Department of Health (DOH). The parents must then complete an educational component prepared by the DOH, sign an informed consent with a refusal to vaccinate statement and a signed statement of understanding that the unimmunized child may be removed from school during an outbreak.
Arkansas Exemption Application (Scanned Green Form for 2005-2006) only
(.pdf) VaccineTruth.net/letters/Dear Parent/Guardian or College/University Student
Scanned Green Form 2005-2006 for viewing only. Do not use this one!
(.pdf) VaccineTruth.net/letters/Refusal To Vaccinate and Statement of Understanding
WARNING!! Do not use the above Refusal To Vaccinate scanned form!! There is deliberate trickery in the language of the above form that can legally be used against you.
See:
AnaiRhoads.org Why Signing a Waiver to Avoid Vaccines Can Be Considered Abuse
She is referring to the Refusal To Vaccinate From developed by The American Academy of Pediatrics, not a regular religious or conscientious exemption letter or form.
Use these Modified Refusal To Vaccinate Forms below. The language trickery has been edited out to keep you legally safe. Print out on pastel green paper to reflect for 2005-2006 school year.
(.doc)
VaccineTruth.net/letters/Modified Refusal To Vaccinate and Statement of Understanding
(.pdf)
VaccineTruth.net/letters/Modified Refusal To Vaccinate and Statement of Understanding
See another WARNING below about signing these state approved forms. See this letter from our director, Ingri Cassel, before you consider signing these kinds of forms and why...
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: https://iris.idhw.state.id.us/irisweb/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.
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 Dr. Faye Boozman, Director of the Arkansas Department of Health.
If you need assistance, the staff of the "American Family Voice" newspaper will provide that assistance. You may call the Voice at 479-880-2026 or email us at theafvoice@cox-internet.com. AFV reports on alternative/complementary healthcare as well as the truth that major media ignores. AFV staffers are members and officers of the Arkansas Health Freedom Coalition, www.arhfc.org.
Daycare & Preschools:
Arkansas Exemption Application (Scanned Green Form for 2005-2006) only
(.pdf) VaccineTruth.net/letters/Dear Parent/Guardian or College/University Student
Use these Modified Refusal To Vaccinate Forms below. The language trickery has been edited out to keep you legally safe. Print out on pastel green paper for 2005-2006 school year.
(.doc)
VaccineTruth.net/letters/Modified Refusal To Vaccinate and Statement of Understanding
(.pdf)
VaccineTruth.net/letters/Modified Refusal To Vaccinate and Statement of Understanding
The letters and affidavits below are not state approved for applying for exemption. These are optional, and useful in case you are asked for further explanation when requesting state exemption form.
(.doc) VaccineTruth.net/letters/Arkansas Exemption letter (applying for state issued exemption).doc
(.doc) VaccineTruth.net/letters/AFFIDAVIT for Arkansas Older Child.doc
Both letters are available in WordPerfect (.wpd) format.
Contact us.
While these letters are not approved and required by the state; they can still be helpful in obtaining the state issued Certificate of Exemption. The state issued form is required.
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 Dr. Faye Boozman, Director of the Arkansas Department of Health.
If you need assistance, the staff of the "American Family Voice" newspaper will provide that assistance. You may call the Voice at 479-880-2026 or email us at theafvoice@cox-internet.com. AFV reports on alternative/complementary healthcare as well as the truth that major media ignores. AFV staffers are members and officers of the Arkansas Health Freedom Coalition, www.arhfc.org.
Schools:
Arkansas Exemption Application (Scanned Green Form for 2005-2006) only
(.pdf) VaccineTruth.net/letters/Dear Parent/Guardian or College/University Student
Use these Modified Refusal To Vaccinate Forms below. The language trickery has been edited out to keep you legally safe. Print out on pastel green paper for 2005-2006 school year.
(.doc)
VaccineTruth.net/letters/Modified Refusal To Vaccinate and Statement of Understanding
(.pdf)
VaccineTruth.net/letters/Modified Refusal To Vaccinate and Statement of Understanding
The letters and affidavits below are not state approved for applying for exemption. These are optional, and useful in case you are asked for further explanation when requesting state exemption form.
(.doc) VaccineTruth.net/letters/Arkansas Exemption letter (applying for state issued exemption).doc
(.doc) VaccineTruth.net/letters/AFFIDAVIT for Arkansas Older Child.doc
Both letters are available in WordPerfect (.wpd) format.
Contact us.
While these letters are not approved and required by the state; they can still be helpful in obtaining the state issued Certificate of Exemption. The state issued form is required.
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 Dr. Faye Boozman, Director of the Arkansas Department of Health.
If you need assistance, the staff of the "American Family Voice" newspaper will provide that assistance. You may call the Voice at 479-880-2026 or email us at theafvoice@cox-internet.com. AFV reports on alternative/complementary healthcare as well as the truth that major media ignores. AFV staffers are members and officers of the Arkansas Health Freedom Coalition, www.arhfc.org.
Colleges & Universities:
Most colleges are requiring the state issued exemption form same as preschools and schools. The same procedures apply.
This AFFIDAVIT can be used, if your college or university requires you to submit your own letter. Some colleges may have their own versions that can sometimes be found online.
Note:
Most colleges have their own meningitis and Hepatitis B vaccine waiver forms which are required. You would use the waivers in addition to this AFFIDAVIT, since other vaccines, specifically MMR and sometimes tetanus, are required.
(.doc) VaccineTruth.net/letters/AFFIDAVIT for Arkansas Adult.doc
(.wpd) VaccineTruth.net/letters/AFFIDAVIT for Arkansas Adult.wpd
This AFFIDAVIT can also be edited for other states that require your own submission or if they are asking you to attach additional information to their own forms.
UAMS (University of Arkansas) College of Nursing
Hepatitis B Vaccine Waiver
(.pdf) http://nursing.uams.edu/inhouse/HEPATITIS%20B%20VACCINE%20WAIVER.pdf
University of Central Arkansas
Persons seeking religious exemption should fill out section B on the back of this form University of Central Arkansas Certificate of Immunization
(Religious Exemption on last page)
(.pdf)
http://www.uca.edu/divisions/international/pdf/certofimmunization.pdf
North Arkansas College
(.pdf)
HEP_B_VACCINE_LISTING_or_waiver-affidavit.pdf
Varicella SCREENING/VACCINE REFUSAL
(.pdf)
VARICELLA_VACCINE_Consent-Decline_Form.pdf
For other required vaccines such as MMR, etc..., you will need to submit the required paperwork and claim an exemption.
If a college requires you to submit your own then you may use this AFFIDAVIT.
(.doc) AFFIDAVIT for Arkansas Adult.doc
(.wpd) AFFIDAVIT for Arkansas Adult.wpd
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:
This same AFFIDAVIT can be used for employment situations as well.
(.doc) VaccineTruth.net/letters/AFFIDAVIT for Arkansas Adult.doc
(.wpd) VaccineTruth.net/letters/AFFIDAVIT for Arkansas Adult.wpd
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
TB Test:
TB test required University of Central Arkansas - For international students only
Required at NORTH ARKANSAS COLLEGE DEPARTMENT OF SURGICAL TECHNOLOGY
Southeast Arkansas College Emergency Medical Technology - TB test required.
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
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 ask specifically for a pathogen scan, especially TB. You will also need to request a printout with the results.
Here are some of the practitioners for Arkansas
Arkansas BEST™ BioMeridian Practitioners:
Please call contact below to find BioMeridian practitioners in your area or closeby.
Oksana Gorodetsky
Marketing/Administrative Coordinator
BioMeridian International
12411 South 265 West, Suite F
Draper, UT 84020
T 801-501-7517
F 801-501-7518
Toll Free 888-224-2337
ogorodetsky@biomeridian.com
Arkansas QXCI Practitioners:
http://www.qxciscio.com/qxci-arkansas-ar.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 1-888-249-1421.
ARHFC
Presidents
Phone: 479-637-4361
Email Address: arhfc@lycos.com
