MISSOURI - IMMUNIZATION EXEMPTIONS by State (includes current statutes, letters & forms)IMMUNIZATION EXEMPTIONS by State (includes current statutes, letters & forms)Missouri Current Statutes & Laws: http://www.nvic.org/Vaccine-Laws/state-vaccine-requirements/missouri.aspx Medical & Religious A child is exempt if a parent objects in writing to the school administrator that immunization of that child violates his/her religious beliefs. This exemption should be made on a Department of Health and Senior Services Form Imm.P.11A, and shall be placed on file with the school immunization health record. For additional help with exemptions, birth plan,etc questions: Non_Vaccinating_Physicians Check our Vaccination Liberation State Chapter and other resource organizations page for help in your state. If your state specific help is not available, Contact us.
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. Hearing Screening... MISSOURI Statute: 191.925. 1 5. The provisions of this section shall not apply if the parents of the newborn or infant object to such testing on the grounds that such tests conflict with their religious tenets and practices. 6. As provided in subsection 5 of this section, the parent of any child who fails to have the hearing screening test administered after notice of the requirement for such test shall have such refusal documented in writing. Such physicians, persons or administrators shall obtain written refusal and make such refusal part of medical record of the infant, and shall report such refusal to the department of health and senior services in a manner prescribed by the department. [Source: Missouri Revised Statutes, Chapter 191, Health and Welfare, Sec. 191.925, 2001] 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://vaclib.org/chapter/inserts.htm#vitK"WARNING - INTRAVENOUS USE Severe reactions, including fatalities, have occurred during and immediately after the parenteral administration of AquaMEPHYTON® (Phytonadione)."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. Or order directly from Amazon.com Biotics Research, Bio-K Mulsion - 1 fl oz 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. 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 AFFIDAVIT I/We, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being(s), state Citizen(s) of the Missouri 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://vaclib.org/chapter/inserts.htm#vitK "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, Statute: 191.925, and, [insert Missouri newborn screening/immunization exemption birth statutes here] 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 Missouri 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: 191.925. 1 5. The provisions of this section shall not apply if the parents of the newborn or infant object to such testing on the grounds that such tests conflict with their religious tenets and practices. 6. As provided in subsection 5 of this section, the parent of any child who fails to have the hearing screening test administered after notice of the requirement for such test shall have such refusal documented in writing. Such physicians, persons or administrators shall obtain written refusal and make such refusal part of medical record of the infant, and shall report such refusal to the department of health and senior services in a manner prescribed by the department. [Source: Missouri Revised Statutes, Chapter 191, Health and Welfare, Sec. 191.925, 2001] 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 Generic Vaccine Refusal Form from Dr. Sherri Tenpenny's webpage. (.pdf) http://www.drtenpenny.com/forms/State Form Required: Yes. Form Imm.P.11A is usually required by schools and daycare centers. Daycare & Preschools: Form Imm.P.11A Vaccine Law in Missouri: 19 CSR 20-28.040 Day Care Immunization Rule Form Imm.P.11A is available to Print on Page 5 of the above PDF. Note: use your PDF reader to "print", select the correct page, etc. 2. A parent or guardian exemption, by which a child shall be exempted from the requirements of this rule if one (1) parent or guardian files a written objection to immu- nization with the day care administrator. The Department of Health and Senior Services’ form Imm.P.11, included herein, shall be signed by the parent or guardian and placed on file with the immunization record of each child with a parental exemption. The parental exemption must be renewed annually. Schools: Vaccine Law in Missouri: 19 CSR 20-28.010 Immunization Requirements for School Children Form Imm.P.11A is available to Print on Page 5 of the above PDF. 2. Religious exemption. A student shall be exempted from the immunization require- ments of this rule as provided in section 167.181, RSMo, if one (1) parent or guardian objects in writing to the school administrator that immunization of that student violates his/her religious beliefs. This exemption on Department of Health and Senior Services form Imm.P.11A, included herein, shall be signed by the parent or guardian and placed on file with the school immunization health record. This need not be renewed annually. Note the difference between daycare and schools regarding renewing the exemption. 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.pdfUNDERGROUND ACTION ALLIANCE STUDENT OPT OUT FORM (.pdf) http://www.militaryfreezone.org/opt_out.pdf (.doc) http://veterans4peace.org/opt_out.docSAMPLE ENGLISH - BINGUAL FORMS FOR OPTING OUT Act to Protect Your Privacy from Military Recruiters (.pdf) http://www.afsc.org/content/opt-out-form 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.docSTUDENT OPT-OUT NOTICE - Google Search Colleges: MISSOURI WESTERN STATE COLLEGE Esry Student Health Center (.pdf)
http://www.mwsc.edu/healthserv/pdf/ImmExempt.pdf (.pdf)
Second Link (.pdf)
Third Link I request exemption from immunization requirements based on the following: My religious/cultural beliefs prohibit immunizations. (Indicate rationale and attach statement from clergy or other authority.) Good religious reasons... These constitute good reasons when a school or college asks for your religious reason on a form that says, state your reason here or attach rationale. Oftentimes, you will be requested to state your rationale for your vaccination exemption petition. What follows is what is used for public schools, parochial schools, private colleges, and public universities. Q: What constitutes a religious conflict with vaccination? A: All vaccines are made in violation of God’s Word. Vaccines are made with toxic chemicals that are injected into the bloodstream by vaccination. All vaccines are made with foreign proteins (viruses and bacteria), and some vaccines are made with genetically engineered viral and bacterial materials. A conflict arises if you believe that man is made in God’s image and the injection of toxic chemicals and foreign proteins into the bloodstream is a violation of God’s directive to keep the body/temple holy and free from impurities. Vaccines are produced in animal tissues. A conflict arises if you accept God’s warning not to mix the blood of man with the blood of animals. Some vaccines are produced in aborted fetal tissue. A conflict arises if your 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. When it is believed that the practice of abortion should not be encouraged or supported in any manner, a conflict may arise with vaccines produced in aborted fetal tissue even though you didn’t have anything to do with the abortions from which the vaccines are made from. The Hepatitis-A vaccine containing MRC-5 is obtained from human babies that were electively aborted. WI-38 was created from the tissue of an aborted fetus and is used for the rubella portion of the MMR-II vaccine. RA 273 was created from the tissue of an aborted fetus, and is used for MMR-II vaccine. 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 this/these vaccine(s) promotes/promote abortion and violates the Sixth Commandment of "Thou Shall Not Kill". The Chickenpox (Varivax) vaccine containing MRC-5 and RA 273, is obtained from human babies that were electively aborted. The acceptance of this vaccine 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. For a child under age 18, where parent has to make the statement, concerning Hep B vaccine... The Hepatitis-B vaccine protects against a disease that is only transmitted through multiple sexual partners or street IV drug users and therefore usurps my parental authority to condemn such activity in my child. The acceptance of this vaccine promotes sexual promiscuity and immoral behavior in direct contradiction to the teachings of our faith. ”I believe that inherent in each individual is an innate intelligence, provided by God, which will protect the host environment and provide homeostasis.” “Life and physical health are precious gifts entrusted to us by God. We must take reasonable care of them…” [2288 – Catechism of the Catholic Church 1994] “The virtue of temperance disposes us to avoid every kind of excess: the abuse of … medicine.” [2290 – Catechism of the Catholic Church 1994] (Indicate rationale and attach statement from clergy or other authority.) You do not need to belong to a church or religious organization to claim religious exemption from vaccines. 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. Click here to view this older version of the AFFIDAVIT for Missouri Adult. Use the updated version below UNIVERSITY OF MISSOURI - COLUMBIA SCHOOL OF MEDICINE Exemption on page 2 EXEMPTION FOR RELIGIOUS/PHILOSPHICAL REASONS This is to certify that I,________________________________________________________ Student Name (print or type) Object to receiving measles and/or rubella immunizations for religious or philosophical reasons. I understand that I am subject to exclusion from the University campus when outbreaks of measles and/or rubella occur. (.doc) http://www.muhealth.org/~medicine/src/APP_LCME_Revised.docMeningococcal Vaccination Policy Compliance Form Section 2 Waivers (complete part A or B) To be completed by students 18 years of age or older A. I do not choose to get the meningococcal vaccine at this time. For students under the age of 18: B. I do not want _______________________________to get the meningococcal vaccine at this time. (.pdf) http://www.umsystem.edu/ums/departments/fa/management/records/forms/other/um55.pdfAFFIDAVIT for Missouri Adult (college & employment religious exemption) ... Edit as needed... AFFIDAVIT I, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being, state Citizen of the Missouri 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 the immunization requirement, and the Mantoux (PPD) Tuberculin Test, 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 [insert Missouri college exemption statute here, or leave blank for employment situations] 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. 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 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 Missouri 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___ 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: Missouri Certificate of Attest: http://hometown.aol.com/mccfhc/certificate.htm Hepatitis A Vaccine Medical Exemption Form: (.pdf)
http://stlouisco.com/doh/forms/medexmpt.pdf (.pdf)
Hepatitis A Vaccine Medical Exemption Form Second Link Hepatitis A Vaccine Religious Exemption Form: (.pdf)
http://stlouisco.com/doh/forms/rel_exmpt.pdf Hepatitis A Vaccine Religious Exemption Form:  (.rtf)
http://members.aol.com/_ht_a/mccfhc/StLHepAexempt.rtf This form is available in PDF format. Email us if you want the PDF version. 807.305 Hepatitis A vaccination 4. The requirements of this section shall not apply to women while they are pregnant, nor to those persons who object to vaccination because of religious beliefs or because of medical contraindications which are verified in writing by a duly licensed physician. 807.305 (4) US Fish and Wildlife Service Form 3-2283 Hepatitis B Immunization Consent/Refusal Form (.pdf)
http://www.fws.gov/forms/3-2283.pdfMost 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 and/or Lead Testing TB-Links/Exemptions Generic letter for Exemption to TB Testing: HTML (text): Exemption-tb-test.html MS Doc file: Exemption-tb-test.doc OSHA Standard Interpretations 09/23/1997 - The Bloodborne Pathogen Standard and the Enforcement Procedures for TB. "Finally, be aware that participation in the employer's skin testing program is voluntary on the part of the employee. OSHA does not require that employees participate in TB skin testing, only that the employer make such skin testing available to employees." TB and Lead Testing Links: F L Y E R LETTER Exemption_Letters OSHA_and_TB_test Tubersol Treatment TB_Screening Alternatives/QuantiFERON_TB_Gold_testimony The above TB and Lead exemption letters are courtesy of Deirdre DeVane of Wash DC. Thank you Deirdre! The adult TB letters were edited by Sherri Tenpenny. Thank you Sherri! 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 Missouri Missouri 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 Missouri QXCI Practitioners: Lifestyle Wellness Center Daniel Smith 307 Main St. Pineville, Mo 64856 417-223-4103 service@lifestylewellnesscenter.com Web Address: www.lifestylewellnesscenter.com And here... http://www.theqxci.com/practitioners.php#central Main page of practitioners: http://www.theqxci.com/information.php For information on purchase or lease of the new Quantum Life BioFeedback L.I.F.E. System, please email Donna at Exemptions Contact Page Please leave your name, mailing address, phone number and contact email. Information will be sent to you from the company only. 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 1-407-672-6144. Information on this page is provided and sponsored by: 
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