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
& Philosophical/Other
"Quick Fact: NVIC Note: Loss of personal exemption for MMR effective July 28, 2019."
[But medical and religious are still OK for MMR ...]
OLDER * * * Important Change to Washington State Exemption Law * * *
Changes to School and Child Care Immunization Exemptions
On May 10, 2011, Governor Gregoire signed a bill that requires a licensed health care provider to sign the Certificate of Exemption for a parent or guardian to exempt their child from school and child care immunization requirements. The signature verifies that the provider gave the parent or guardian information about the benefits and risks of immunization. A parent or guardian can also turn in a signed letter from a health care provider stating the same information.
The law took effect on July 22, 2011. It only applies to exemptions requested after this date.
A health care provider doesn't need to sign the form for parents or guardians who demonstrate membership in a church or religious
group that does not allow a health care provider to provide medical treatment to a child.
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.
Washington State specific information Medical Treatment Refusal
Replace the paragraph (near bottom of page 1) of the generic AFFIDAVIT above with your state law as follows: [Make sure you replace with your name, status, and name of child.]
(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, RCW 70.83.020 and RCW 28A.210.090 to receive Religious Exemption from Vaccination, ALL injections, & testing.
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
Washington 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)_________."
Washington State specific information New Born Screening
New Born Screening Washington state
Religious Exemption from newborn screening allowed. Wash. Rev. Code § 70.83.020
RCW 70.83.020 Screening tests of newborn infants. It shall be the duty of the department of health to require screening tests of all newborn infants
before they are discharged from the hospital for the detection of phenylketonuria and other heritable or metabolic disorders leading to mental retardation or physical defects as defined by the state board of health: PROVIDED, That no such tests shall be given to any newborn
infant whose parents or guardian object thereto on the grounds that such tests conflict with their religious tenets and practices.
[1991 c 3 § 348; 1975-'76 2nd ex.s. c 27 § 1; 1967 c 82 § 2.]
Parental Right to Refuse
(iv) The legal right of parents or responsible parties to refuse testing because of
religious tenets or practices as specified in RCW 70.83.020
PARENTAL RIGHT TO REFUSE
According to law (Chapter 70.83 RCW – PHENYLKETONURIA AND OTHER
PREVENTABLE HERITABLE DISORDERS), a newborn screening specimen should
not be obtained on any newborn infant
"whose parents or guardians object thereto on the grounds that such tests conflict with their religious tenets and
practices". If parents do refuse, it is the responsibility of the health care facility to obtain the signature from the parent(s) on the reverse side of the screening card to document the refusal. The provider must make certain that the parent(s) understand the risks of refusing the screening. As with collected specimens, the demographic information should be completed and the signed card forwarded to the Newborn Screening Program within 24 hours. The refusal should be noted in the infant's medical record.
It is important to note that religious reasons are the only valid basis for refusal. Newborn screening statistics indicate that the majority of infants whose parents signed a refusal in the hospital were later tested, indicating that the initial refusal was not truly based on religious principles. Affected infants could have a delayed diagnosis for several days or possibly weeks, thus placing them at significant risk of permanent damage or possibly death. The risk of refusal should be made clear to parents and refusals should not be accepted for any other reason.
This proves to the hospital that religious exemption is allowed for newborn screening in Washington State.
It can and should be used with the Model Birth Plan letters. Since there is no refusal form or religious exemption form in the manual,
you will need a typed religious exemption affidavit to go along with the Model Birth Plan letter. It is important to cite the state code
RCW 70.83.020
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
Available Exemptions: Medical | Religious and Philosophical
State form required: Yes (see links below)
Also note that Certificate of Immunization Status (CIS) forms are now separate from Certificate of Exemption (COE) forms.
Religious and philosophical or personal exemption forms must be signed by a "health care practitioner."*
((MD, DO, ND, PA, ARNP).
Exception:
"I am a member of a church or religious body whose beliefs or teachings
do not allow for medical treatment from a health care practitioner. By
supplying the information requested below, no further proof or signed
provider statement is required for this religious exemption.”
* A letter may substitute for a signed ‘Provider Statement’ on the COE. To be accepted, the letter must reference the child’s name on the certificate, confirm that the child’s parent
or guardian got information on the risks and benefits of immunization to their child, and be signed by a licensed health care provider.
28A.210.090 - Immunization program — Exemptions. RCW 28A.210.090 Immunization program—Exemptions.
[Exerpts below, see link for current and complete reading.] (1) Any child shall be exempt in whole or in part from the immunization measures required by RCW 28A.210.060 through 28A.210.170 upon the presentation of any one or more of the certifications required by this section, on a form prescribed by the department of health: (a) A written certification signed by a health care practitioner that a particular vaccine required by rule of the state board of health is, in his or her judgment, not advisable for the child: PROVIDED, That when it is determined that this particular vaccine is no longer contraindicated, the child will be required to have the vaccine; (b) A written certification signed by any parent or legal guardian of the child or any adult in loco parentis to the child that the religious beliefs of the signator are contrary to the required immunization measures; or (c) A written certification signed by any parent or legal guardian of the child or any adult in loco parentis to the child that the signator has either a philosophical or personal objection to the immunization of the child. A philosophical or personal objection may not be used to exempt a child from the measles, mumps, and rubella vaccine. (2)(a) The form presented on or after July 22, 2011, must include a statement to be signed by a health care practitioner stating that he or she provided the signator with information about the benefits and risks of immunization to the child. The form may be signed by a health care practitioner at any time prior to the enrollment of the child in a school or licensed day care. Photocopies of the signed form or a letter from the health care practitioner referencing the child's name shall be accepted in lieu of the original form.
* * * Important Change to Washington State Exemption Law * * *
Changes to School and Child Care Immunization Exemptions
On May 10, 2011, Governor Gregoire signed a bill that requires a licensed health care provider to sign the Certificate of Exemption for a parent or guardian to exempt their child from school and child care immunization requirements. The signature verifies that the provider gave the parent or guardian information about the benefits and risks of immunization. A parent or guardian can also turn in a signed letter from a health care provider stating the same information.
The law took effect on July 22, 2011. It only applies to exemptions requested after this date. A health care provider doesn't need to sign the form for parents or guardians who demonstrate membership in a church or religious group that does not allow a health care provider to provide medical treatment to a child.
If colleges refuse to grant a waiver, be prepared to get legal help. Use
THE ACCEPTANCE OF RESPONSIBILITY FORM This form is imperative in exercising your rights for legal exemptions from forced medical experimentation and legalized bioterrorism. DO be prepared to fight for the right to own your body and to obtain a college education.
Evergreen State College - Olympia, Washington Measles Immunization Waiver on page 2. Looks like this:
WAIVER Due to medical, religious, personal or other reasons I choose to decline immunization. In the event of a Measles outbreak on campus, I agree to comply with quarantine or isolation procedures as recommeded by the Center for Disease Control and the local Public Health Department. I understand that this will likely result in missing classes or any other campus activity, including student employment, for the duration of exposure risk.
STUDENT SIGNATURE_________________________________ DATE:_______________ (.pdf) MeaslesForm.pdf
University of Washington
Waiver Applications for the Practicum MPH Immunization Waiver Application
This form is no longer online, however you may ask for the above form at the school. Also you may use the affidavits below and/or perhaps try the Washington Certificate of Exemption Form.
Washington State specific information for various Opt-Outs
Vaccine Registry Opt-Outs:
What if I do not wish to participate?
If you don't want your child's immunizations entered into the IIS, talk with your doctor or nurse.
If they use the system, they can take steps to honor your request.
You may also contact the Washington State Department of Health at:
Washington State Immunization Information System
Office of Immunization and Child Profile
PO Box 47843
Olympia, Washington 98504-7843
Phone: 360-236-3595 or 1-866-397-0337
OptOutRegistry for Vaccines and various other Opt-Outs
Vaccine Registry Opt-Outs:
KNOW YOUR RIGHTS
Confidentiality of Your Child’s Vaccination Records
FERPA: The Family Educational Rights and Privacy Act vaxchoicevt.com
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]
(.doc) 
(.pdf) 
(.doc)