Deliberate Trickery

What I’m referring to is the sudden influx of some state exemption/waiver forms that use
deliberate trickery in the language to catch unsuspecting parents off guard. It is modeled after
the American Academy of Pediatrics "Refusal To Vaccinate" form.

Lately, we have seen a sudden rise in these types of forms. The question is why?

Are any of you aware of this form? If not, please continue reading. Please check your state
statute if ever asked to use these forms. Insist they show you where it’s required.

“By endorsing this particular waiver, parents would essentially be signing an

admittance of neglect and or "abuse" for refusing vaccines. The language
contained in this waiver could put parents and caregivers in jeopardy down-the-
line if they should ever find themselves in the courts due to their child's health
problems, when confronted with child protective services, divorce, or just about
any matter pertaining to that child that could be used against the parent(s)”.
~Anai Rhoades Ford
Why Signing a Waiver to Avoid Vaccines Can Be Considered Abuse by Anai Rhoads Ford.
http://www.anairhoads.org/medical/saynotovaccines.shtml

Parents and caregivers Beware!

Some states have it in their state exemption statutes such as Arkansas in order to obtain the
exemptions. http://www.vaclib.org/exempt/arkansas.htm
We took the “Refusal To Vaccinate” form and modified it to keep parents safe legally.
http://www.vaclib.org/letters/Mod_ARvax2.doc
http://www.vaclib.org/letters/Mod_ARvax2.pdf

For help and local support in Arkansas contact:

Arkansas Health Freedom Coalition
ARHFC
PO Box 733
Waldron, Arkansas 72958
Presidents Phone: 479-637-4361
Email Address: arhfc@lycos.com

Other states such as Idaho and Tennessee are not required by law to use this form.

Here’s what was found in Tennessee:

Religious Exemptions may be granted to a student whose parent/guardian files with the school a
Vaccination(s) Refusal Due To Personal Religious Beliefs document.
Note: This form must be signed by a Notary Public.
Actual form: http://kcs2.knox.k12tn.net/kcsforms/AD/AD-H-337.pdf
Also in Rutherford County Schools (only the information about it is mentioned)
http://www.rcs.k12.tn.us/rc/general/registration_info.htm
These forms need to be edited by crossing some things out.
Idaho has a similar form as well, but it is not required by law. I.C. § 39-4804
See how we edited the Idaho state form Idaho’s page. http://www.vaclib.org/exempt/idaho.htm

Here are examples of deliberate trickery in the wording of this State of Idaho forms:
Be sure to cross out ALL the “nots” if you are asked to use these forms.
Page 1 of the form...

Please read the following statements and initial each statement regarding vaccine preventable diseases for which an
exemption is being claimed.

Diphtheria: I understand by not receiving the Diphtheria vaccine, my child is at risk of developing a sore throat,
low-grade fever, heart complications, paralysis, respiratory complications, coma and even death.
__________ _______________
Initial Date

Tetanus: I understand by not receiving the Tetanus vaccine, my child is at risk of developing seizures and possible
fatal neuromuscular disease.
__________ _______________
Initial Date

Pertussis (Whooping Cough): I understand by not receiving the Pertussis vaccine, my child is at risk of developing
pneumonia, seizures, inflammation of the brain, neurological complications and even death.
__________ _______________
Initial Date

Polio: I understand by not receiving the Polio vaccine, my child is at risk of developing a fever, sore throat, nausea,
headaches, stomachaches, stiffness, and paralysis that can lead to permanent disability and death.
__________ _______________
Initial Date

Measles: I understand by not receiving the Measles vaccine, my child is at risk of developing a rash, high fever,
cough, runny nose, red, watery eyes, diarrhea, ear infections, pneumonia, encephalitis, seizures, and death.
__________ _______________
Initial Date

Mumps: I understand by not receiving the Mumps vaccine, my child is at risk of developing a fever, headache,
muscle aches, swelling of the lymph nodes close to the jaw, meningitis, inflammation of the testicles or ovaries,
sterility, arthritis, inflammation of the pancreas and deafness (usually permanent).
__________ _______________
Initial Date

Rubella (German Measles) I understand by not receiving the Rubella vaccine, my child is at risk of developing a
rash and fever in children and young adults, birth defects if acquired while pregnant include deafness, cataracts,
heart defects, mental retardation, and liver and spleen damage.
__________ _______________
Initial Date

Hepatitis B: I understand by not receiving the Hepatitis B vaccine, my child is at risk of developing yellow skin or
eyes, tiredness, stomachaches, loss of appetite, nausea, or joint pain, life-long liver problems, such as scarring of the
liver and liver cancer.
__________ _______________
Initial Date
More deliberate trickery of the wording on Page 2:

"I know that failure to follow the recommendations about vaccination may endanger the health
or life of my child and others that my child might come in contact with. I acknowledge that I
have read this document in its entirety and fully understand it."

You could alter the form and say:

"I know that failure to follow(ing) the recommendations about vaccination may endanger the
health or life of my child and others that my child might come in contact with. I acknowledge
that I have read this document in its entirety and fully understand it."

"RELIGIOUS or PERSONAL STATEMENT: I have investigated the risks of not vaccinating my

child; nevertheless (therefore) I have decided to not vaccinate my child for the following
reason(s):" __________________________________
(You may attach one of our Vaccination Liberation Idaho Exemption Forms, or simply cite I.C.
§ 39-4804)

Please be aware that not all state issued exemption/waiver forms contain this deliberate trickery
in the language. Write your own forms, if the state statute allows it and use our ACCEPTANCE
OF RESPONSIBILITY form. http://www.vaclib.org/legal/accept1.htm

This is a SAFE form you can use that we modified:

http://www.vaclib.org/letters/RefuseVaccines1.pdf

This is the UNSAFE form that you should NEVER use.

http://www.cispimmunize.org/pro/pdf/RefusaltoVaccinate_2pageForm.pdf

See the differences?

Donna Carrillo, co-director

Vaccination Liberation
http://www.vaclib.org
Services4Health@aol.com

"Ask me about vaccine exemptions"