Date:   7/25/2006 2:06:54 PM ( 18 y ago)
Hits:   16,139
URL:   https://www.curezone.org/forums/fm.asp?i=363667

Here's all the forms and legal information you need to get your child/children exempted from vaccines in California. Just click the link below, and you're there!

Unyquity


http://www.vaclib.org/exempt/california.htm

State Form Required: No.

The California immunization record (pm286b) can be used.
California School Immunization Record (exemption on back) pm286b.pdf

Daycare & Preschools:

Rosamond Bible Preschool
Exemption from Immunization form
http://www.rbpsol.com/Forms/Immunization.doc
Available in Adobe PDF. Please email us at Exemption Contact Page. Ask for California Rosamond Bible Preschool Exemption from immunization form.

Other preschool and daycare facilities may use this form.
http://www.dhs.ca.gov/publications/forms/pdf/pm286b.pdf
Vaccine & TB test exemption also in Spanish on back of form.

Waiver of health examination. Page 1 is English, Page 2 is Spanish.
http://www.dhs.ca.gov/publications/forms/pdf/pm171b(bi).pdf.

PM 286 B (1/02) California School Immunization Record (fill-in)

AFFIDAVIT for California Older Child (for daycare, preschool or school) below... AFFIDAVIT

Comes now, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being, state Citizen of the California Republic. 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 California Health & Safety Code #120365 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 Creator Yahweh 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 California

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___
Schools:

PM 286 B (1/02) California School Immunization Record (fill-in)

VALLEY CHRISTIAN ELEMENTARY SCHOOL
HEALTH EXAM FORM
IMMUNIZATION EXEMPTION FOR PERSONAL BELIEFS:
Bottom of page 1, sign and date.
http://www.dublinvcc.org/schools/elmentary/forms/health_form.pdf

http://www.dhs.ca.gov/publications/forms/pdf/pm286b.pdf
Vaccine & TB test exemption also in Spanish on back of form.

Waiver of health examination. Page 1 is English, Page 2 is Spanish.
http://www.dhs.ca.gov/publications/forms/pdf/pm171b(bi).pdf.

Same health examination waiver form at other websites...
http://www.ieminc.org/Enrollment/Health%20Waiver.pdf
http://www.dhs.ca.gov/publications/forms/pdf/pm171b(bi).pdf

Exemption information
http://www.dhs.ca.gov/ps/dcdc/izgroup/pdf/imm488e.pdf

Vaccine Exemption Letter from Planet Raw
http://www.planetraw.com/vaccinationexempt.php

California Philosophical Belief Exemption from School vaccinations Health & Safety Code #120365

SAMPLE EXEMPTION LETTER

Date
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.

Colleges & Universities:

WARNER PACIFIC COLLEGE Measles (Rubeola) Immunization Record/Exemption Form
http://www.warnerpacific.edu/Admissions/pdf/mmr.pd...

CA State Fullerton University Hep B and MMR vaccine waiver form http://www.fullerton.edu/shcc/pdfs/Waiver_Form.pdf

University of California, San Diego Hepatitis B Statement
Hep B Vaccine Waiver (page 2) (Students)
http://studenthealth.ucsd.edu/pdfdocs/hepbreqstatement.pdf

CSU, San Marcos
Student Health & Counseling Services
San Marcos, CA 92079-0001
Fax Number: 760-750-3181
Phone Number: 760-750-4915
Certificate of Immunization for Cal State San Marcos
(Exemption at bottom of form)
http://www.csusm.edu/shs/PDF%20Filesforms/Certificate%20of%20immunization.pdf

University of Southern California
HEPATITIS B VACCINATION DECLINATION FORM (University Students)
http://www.usc.edu/student-affairs/Health_Center/docs/ec.hepatitis.b.vaccinat...

California State University, Chico
STUDENT IMMUNIZATION CERTIFICATION
Bottom of page EXEMPTION FROM IMMUNIZATION: To request exemption, check the item which applies to you, and sign your name in the space provided below.
http://em.csuchico.edu/sro/Forms/ImmunizationCertification.pdf

Humboldt State University
Student Health Center
Arcata, CA 9552
Immunization Form
Exemption request bottom of page 2.
http://studentaffairs.humboldt.edu/_download/immunization_form.pdf

AFFIDAVIT for California Adult (college religious exemption) ... Edit as needed...
You may use this for employment situtations as well. AFFIDAVIT

Comes now, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being, state Citizen of the California Republic. 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 California Health & Safety Code #120365 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.

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 California

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___

The list below is from: (you'll have more clickable links if you go here, too): http://www.vaclib.org/legal/stateresource.htm#c

California

V.I.A.L. - N. California Chapter
Dr. Don Grundmann, director
425 E. Merle Court
San Leandro, Calif. 94577
510-895-6789
StopTheIRS@aol.com
N. California V.I.A.L. Home Page

Vaccine Information and Awareness (VIA)

Karen Schumacher

12799 La Tortola

San Diego, CA 92129

(858)484-3197/fax 484-1187
http://home.san.rr.com/via
E-mail: kschumacher@san.rr.com

Global Vaccine Awareness League

Michelle Helms-Gaddie

P.O. Box 846

Lake Forest, CA 92630

(949)929-1191

http://www.gval.com

Future Generations

Jane Sheppard

1275 Fourth Street, Suite 118

Santa Rosa, CA 95404

(707)575-5065

sheppard@ap.net

http://www.healthychild.com

Vaccination Awareness & Choice Network

Sheri Nakken, RN, MA

PO Box 1563

Nevada City, CA 95959

530-272-7306

vaccineinfo@btinternet.com

http://www.nccn.net/~wwithin/vaccine.htm

 

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