Never sign a Refusal To Vaccinate if confronted by such a
The best way to avoid it, is avoid the allopaths
I always suggest a naturopath and/or chiropractor.
Here's the page that Dewey put up regarding that.
I have put a page up at:
With two supporting forms at:
Here's the contents of the page below...
Do Not Sign
AAP or other self-incriminating Vaccine Refusal forms
Basically, some doctors are giving patients who chose not to vaccine their
children a form to sign created by the American Academy of Pediatrics (AAP).
This form varies somewhat state to state but basically it is a total
propaganda sheet about the alleged value of vaccines, the alleged "risk"
vaccinating and even worse the parent who signs the form is falsely
that they are putting their children at risk.
Lower on this page we have a letter from our director that explains more
about why self-incriminating forms are to be avoided.
When faced with a request to sign a form which removes liability from your
doctor, you have several options:
* Change doctors to a holistic physician such as a naturopath,
homeopath or other medical provider who does not require you remove the
from their shoulders in the event your child becomes sick.
* Write your own form.
* Use our form 'as is' or modify it to reflect your needs.
WARNING/DISCLAIMER: Please note that the law varies from state to state.
Thus we HAVE NOT asked the advice of a lawyer about what unforeseen
might arise from using this form.
If you do consult a lawyer in your state about using our form, please share
with us the comments you receive. Thanks.
_RefuseVaccines1.doc [MS Word 25K]_
_RefuseVaccines1.pdf [Adobe PDF 87K]_
Note: the intention of this above form is as follows:
* Give the doctor release from liability in case your child acquires
what allegedly is a 'Vaccine Preventable Disease'.
* Avoid the creation of liability for yourself.
* Optional: Give the doctor a little bit of information to make them
* Optional: Also put 'concerned parties' on notice that you have done
* The form avoids telling the doctor why you chose not to vaccinate.
Your reason for not vaccinating is your affair, unless you chose to
For example, you might want the doctor to know that your religion forbids
* Re-write the given form and cross out key words which will change the
document's meaning: I.E. "I am aware of the risks of not vaccinating my
child. [cross out the word "not"]
Examples of a re-written form: _Mod_ARvax2.doc_
(http://www.vaclib.org/letters/Mod_ARvax2.doc) | _Mod_ARvax2.pdf_
Further questions about exemptions: _http://www.vaclib.org/exemption.htm_
If you need to email us about exemptions or exemption forms, _Click here:
The letter below is from our director, Ingri Cassel, and it explains why you
should not sign any self-incriminating form.
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
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
Control and Prevention and used by licensed Idaho daycares, I was shocked
into the VERY REAL danger of signing these forms without changing them
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
needed to fill out for this daycare is posted here:
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
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
funded Child Abuse Prevention and Treatment Act which gives states the
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
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
form that will satisfy the law. Since your parental rights are at stake
is best to be vigilant and err on the side of being overly cautious.
For more background on the problem of self-incriminating Vaccine Refusal
forms see this offsite page: