Sample - California exemption letter - written by Adventist Council member
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School or Governing Authority


City, State, Zip Code

RE: Vaccination Exemption

Dear (Name):

I am writing to request an exemption from (institution name)'s immunization requirements based upon my philosophical objections to the practice of immunization. I am claiming this in accordance with California Health and Safety Code Section 120365, which reads as follows:

Immunization of a person shall not be required for admission to a school or other institution listed in Section 120335 if the parent or guardian or adult who has assumed responsibility for his or her care and custody in the case of a minor, or the person seeking admission if an emancipated minor, files with the governing authority a letter or affidavit stating that the immunization is contrary to his or her beliefs.

This letter serves as my formal request to (institution name) that I be exempt from the required immunizations because this medical practice is contrary to my beliefs. Thank you for your attention to this important matter. If you have any questions do not hesitate to contact me.


Your Name

Enclosure: (YOUR STATE) Health and Safety Code

Xc: Michael Peabody, Esq., Vice President

Seventh-day Adventist Church State Council

Sample - California exemption letter
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School/ Institution
1776 Independence Way
Anytown, CA

To Whom it May Concern,

This letter is to serve as an affidavit, stating that vaccinations are contrary to what I believe is healthy for my child, Child's Name.

Health & Safety Code #120365. states that, it is my legal right to decline such vaccinations for my child.

Thank you kindly,

Legal Parent / Guardian

" Some schools my have their own exemption form, or may use a form provided by the county health dept. However, a straightforward personal communication is better assurance that your rights will be respected.
" The California philosophical belief exemption (health & safety Code #120365.) is your legal right as a parent, to enroll your child in public school without vaccinations.
" The right also applies to legal adults seeking admission to a community college.
" Under the law school authorities can not deny this right. However, they may be unaware of the legal exemption and know only to follow general procedure.
" Private schools are sometimes a challenge and may have their own policies.
" Terrorizing parents with threats of disease to their child for non vaccine compliance is a common practice.
" The media, health agencies and doctors, etc., who proclaim that children (and or college students) can not be admitted to school without hepatitis-B and other vaccines are simply parroting false information.
" Something is very wrong when people are told they do not have rights that they do in fact have.
" The bottom line is; money is made each time any body is vaccinated and "free vaccinations" are not free. They have simply been paid for in advance with your tax dollars.

Note: This information does not constitute legal or medical advice.