For additional help with exemptions, birth plan, etc questions: Check our
Vaccination Liberation State Chapterand other resource organizations located in your state.
If your state specific help is not available, Contact us.
- - - Available Exemptions - - -
Medical &
Religious
Your Choice.
Join thousands of other pioneers in refuting the presumed authority the corporate government has over your life.
Break the presumptions by negating adhesion contracts. Find out if your state's corporate statutes actually apply to you.
Did you sign a contract binding you to adhere to their statutes? Not likely. To learn more,
go to this page. PDF documents (.pdf)
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.
Steps:
Create the Birthplan. Or modify one of our ours to fit your state laws and any other personal circumstances. (see below)
Sign the birthplan in front of a Notary.
Submit the birth plan to your hospital or midwife. Keep a couple extra copies in case plans change.
Make sure affected parties (doctors, nurses, etc) understand your requirements and wishes.
Plan on having one or two trusted persons stay with the mother and
child to watch the child at all times while in the hospital, so no
unwanted injections are given the baby.
The birth plan arrangements and letter should be turned in before delivery date.
Birth Plans GENERAL INFORMATION (To be used with hospitals and/or midwives)
(Links to model birth plan letters)
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...
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)
Model letter for hospital births for adoptions.doc
The birth plan arrangements and letter should be turned in before delivery date.
This "Refusal to Permit Medical Treatment" form below is optional.
Tennessee State specific information Medical Treatment Refusal
None at this time.
GENERAL INFORMATION (Medical Refusal Forms and Affidavit)
1. Make an informed choice as far ahead of birth as possible.
2. See the Black box warning in the
FDA Package Insert for the Injection.
3. Know your options: Pre-Birth Diet, Oral Vitamin K, or synthetic Vitamin K Injection.
GENERAL INFORMATION Vitamin K
Vitamin K Injection...
The Question of Vitamin K for Newborns
"Essentially all human infants are born with very low blood levels of vitamin K and, since low amounts of vitamin K crosses into breast milk, levels remain low for several weeks after birth in breastfed babies. The purpose of this natural, universal experience of low vitamin K levels in newborns is not known. ..."
"Mouse and epidemiologic studies indicate that the neonatal “deficiency” of vitamin K, which promotes cell turnover, may actually protect the developing fetus from damaging substances that “escape the primary placental screen.”
Read the rest of the article here:
http://www.thevaccinereaction.org/
The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert.
Warning
"The injectable form of vitamin K can rarely cause severe (sometimes fatal) allergic reactions when given by injection into a muscle or vein.
Therefore, vitamin K should be injected into a muscle or vein only when it cannot be given by injection under the skin or taken by mouth, or when your doctor has judged
that the benefit is greater than the risk. Seek immediate medical attention if you experience symptoms of an allergic reaction such as rash, itching, swelling, dizziness, or trouble breathing."
Potential exists for the newborn to experience hypersensitivity to any component of this medication.
Each milliliter contains: Phytonadione .. 2 mg or 10 mg
Inactive ingredients:
Polyoxyethylated fatty acid derivative .... 70 mg
Dextrose................................... 37.5 mg
Water for Injection, q.s. .................. 1 mL
Added as preservative: Benzyl alcohol .... 0.9%
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.
Informed Consent Defense (2020 Pilot Survey)
Wonderful Graphs comparing various unvaccinated vs vaccinated disease rates for vaccines and Vitamin K at birth
PDF 4.8MB
Tennessee State specific information Hepatitis B
None at this time.
Hepatitis B Vaccine
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 by asking hospital personal to sign the following waiver. Usually,
you'll never find anybody in the hospital to sign this simple form, but
you well get relief from demands to vaccinate your child.
"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)_________."
Tennessee State specific information New Born Screening
Tennessee: New Born Screening
IMPORTANT! Please download this if you're expecting a child or know someone who is! This proves to the hospital that religious exemption is "allowed" for newborn screening in Tennessee.
The form states that you acknowledge that by refusing the newborn screening for
religious reasons that you are COMMITTING A MISDEMEANOR:
I have been informed that state law requires this testing and that violation of the law is a
misdemeanor.
Nonetheless, I refuse these tests at this time for my newborn baby
_________________________ because such test conflicts with my religious tenets and practices.
Under penalty of perjury, I affirm such refusal because of a conflict with my religious tenets and
practices.
details:
Metabolic/Genetic Newborn Screening Program In Tennessee
1200-15-01-.01 TESTS. (.pdf)
publications.tnsosfiles.com/rules/1200/1200-15/1200-15-01.20130531doc.pdf
(1) Exemptions for religious beliefs. Nothing in this part shall be construed to require the testing
of or medical treatment for the minor child of any person who shall file with the Department of
Health a signed, written statement that such tests or medical treatment conflict with such
person’s religious tenets and practices, affirmed under penalties of perjury pursuant to T.C.A.
§ 68-5-403. The newborn screening refusal form provided by the State should be completed,
filed with the Department and retained in the medical record for the period of time defined by
the hospital or provider policy.
If a parent refuses the newborn screening blood test provide them with the Newborn Screening Refusal Form (PH-3686 )
New Born Screening: General
U.S. states now require screening of newborn babies for specific diseases.
If you take your new baby to an MD as opposed to a naturopath and/or
chiropractor, please be aware of and careful of any forms you sign.
Our WARNING
below is about signing (some) state approved and AAP created forms. See
this letter from our director, Ingri Cassel, before you consider
signing waiver forms.
WARNING!
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:
http://childhealthsafety.wordpress.com/ ...
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.
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
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.
Black's Law Dictionary - Sixth Edition - the definition of Affidavit. This is the dictionary used by the American Bar Association and all
judges/magistrates/attorneys.
Affidavit - A written or printed declaration or statement of facts, made voluntarily, and confirmed by oath
or affirmation of the party making it, taken before a person having authority to administer such oath or affirmation.
[notary]
Warning: Any affidavit we supply is a suggestion or template for you to modify to fit your beliefs or understanding of facts. The
"facts" are those of the person signing the affidavit.
Some definitions for terms on AFFIDAVIT:
Further Affiant Saith Not
Affiant: a person who makes an affidavit.
Saith: A third person singular present tense of say.
Sui Juris: having full legal capacity to act on one's own behalf : not subject to the authority of another
An Adult Affidavit, with Christian beliefs, is here. (MSDOC file)
Feel free to modify as needed.
Dr. Tenpenny had the following forms on her web site. (Now Archived) The forms are generic and may be used in any state. Check any references that might need updating.
Affidavit for Parents Participating in International Adoption (Word) (pdf)
Hep B vaccine in hospital for newborn refusal, sample (pdf)
OSHA Declination Statement Form (also, pdf)
Religious exemption letter that was approved in Florida (Word) (pdf)
School Vaccine Exemption Form, sample (Word) (pdf)
TB testing refusal, sample (pdf)
Childcare and School Immunization Requirements
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.
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!
An index page to various Acceptance of Responsibility) forms is here: .
http://www.vaclib.org/legal/accept.htm
Children with medical or religious exemption to requirements
Medical - Physicians (MD or DO) or Public Health Nurses are authorized to indicate specific vaccines medically exempted
(because of risk of harm) on the certificate. Other vaccines remain required. The medical reason for the exemption
does not need to be provided.
Religious - This exemption requires a signed statement by the parent/guardian that vaccination conflicts with their religious tenets or practices.
If the child needs documentation of a health examination for the school, it must be noted by the healthcare provider on the immunization certificate.
In that case, the provider should check the box in
section 1a. that the parent has sought a religious exemption to explain why immunization information is absent or incomplete.
Source: childcare-12th-grade-immunization-requirements.html
State Form Required: Yes. TCA 49-6-5001(b)(2) Green Official TN Certificate of Religious Exemption. However, some schools have accepted letters from parents, and some schools have their own exemption form.
Religious Exemption Letter. In some districts, you may be required to get the Official Tennessee Certificate of Religious Exemption.
It's a green form. However,you may use this letter to give the health dept to obtain the green form, if necessary. Tennessee religious exemption letter.doc (5226)
VaccineTruth.net/letters/Tennessee religious exemption letter.doc
AFFIDAVIT for Tennessee Older Child below...
Can be used for daycare, preschools and schools, edit as needed and appropriate for your beliefs.
AFFIDAVIT
I/We, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being(s), state Citizen(s) of the Pennsylvania 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 or the Body of my Children. 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 or any of my children's bodies.
This written statement to exempt my child from any immunizations, TB testing, and other shots/injections, 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 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.
(We / I) {First and Last name(s)}, as the {(parent (s) / guardian(s)}of _________________________(name of child) are/am exercising our rights under the First Amendment of the US Constitution and Tennessee Statutes TCA 49-6-5001 (b)(2) to receive Religious Exemption from Vaccination.
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.
Our Creator Yahweh and the Lord Jesus Christ is the only source of protection of my body and that of my family that I can accept.
I affirm that vaccination & injections of any foreign substances and proteins conflict with my religious beliefs as stated above. Therefore, I would request that you accommodate my religious beliefs and practices by exempting my child from any vaccination or injections of any kind.
Rest assured that my family and I 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 Tennessee
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.
Immunization Requirements
The state of Tennessee requires students entering colleges, universities, and technical institutes with enrollment of greater than 200 students to provide proof of
two (2) doses of Measles, Mumps, and Rubella (MMR) vaccine on or after the first birthday or proof of immunity to measles.
In compliance with this law, and in an attempt to maintain a safe and healthy campus environment, Tennessee State University requires that all entering students,
born after
1957, furnish documented proof of having immunity to measles or having been immunized with two doses of MMR vaccine on or after the first birthday unless
contraindicated because of pregnancy, allergy to a vaccine component, or other valid medical reason(s).
The law states that immunizations are not required if they conflict with the parents, or guardians, (or individuals over 18) religious tenets and practices,
affirmed under the penalties of perjury.They are also not required if a qualified physician shall certify that administration of such immunization would be in
any manner harmful to the child involved. (TCA Section 49-6-5001).
The University of Memphis Hepatitis B - Meningitis Immunization Health History Form
The State of Tennessee mandates that The University of Memphis provide information concerning the Hepatitis B infection and Meningococcal disease to all students entering The University of Memphis for the first time. The law does not require that you receive either immunization for enrollment. Student Health Services urges our students to be immunized against Meningococcal Meningitis and Hepatitis B.
ALL new students must complete the Hepatitis B - Meningitis Immunization Health History Form before they can register.
Source:
https://www.memphis.edu/health/pdfs/waiver_form.pdf
The University of Memphis MMR & Varicella
See links below for age requirements and requirements for medical or religious reasons.
When immunizations are medically contraindicated, a physician must provide a signed written statement indicating which immunizations are
contraindicated and why the immunizations are contraindicated and then uploaded at http://umwa.memphis.edu/immunizations/
Religious exemptions may be requested. An original signed and notarized statement, affirmed under penalties of perjury that the vaccination
conflicts with the religious tenets and practices of the student must be submitted to the Student Health Center in-person or by mail.
Source: https://www.memphis.edu/health/pdfs/immun_cert.pdf
(Jackson State CC) MMR: "You provide a signed statement that your religious tenets and practices prohibit the receipt of any
type of immunization (parents must sign if you are under age 18)"
Cumberland University Proof of Medical Vaccinations form
Lebanon, TN 37087-3408
... contact the Office of Admissions for a copy of the Medical Vaccination Waiver Form.
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."
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."
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.
Next (below) in Misc are some QXCI and other practitioners. (If known.)
Misc Info and explanation of QXCI - Etc.
QXCI SCIO EPFX Overview
(The SCIO and the EPFX are the same device.
It is known as the EPFX in the USA and the SCIO world wide.)
Source:
energymedicinereview.com/qxci-scio-epfx.html [Now inactive]
Use Google or other search engine to find a BioMeridian Practitioner in your area.
If you do not find a practitioner, you can contact the current device manufacturer for the practitioner in your area. ihtbio.com/support-and-help/
Tennessee specific information Misc/QXCI
QXCI and BioMeridian providers in Tennessee
Tennessee BEST™ BioMeridian Practitioners: and
Meridian Stress Assessment
Mind-Body Medical Center
Stephen L. Reisman, MD target="_blank"
Website Information including contact Offers a holistic approach to healing including nutrition, uses meridian stress assessment to check for energy imbalances in body.
Tennessee State Sponsors for this page
Contact us if you want to be our supporter in ways other than listed below. Thank you.
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