Guest guest Posted September 21, 2005 Report Share Posted September 21, 2005 http://www.vaclib.org/exempt/california.htm about 1/2 way down the page more at webpage I would use the religious exemption (even though California has a philosophical exemption) 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.vaccina tion.2004.pdf 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___ -------------------------------------------------------- Sheri Nakken, R.N., MA, Classical Homeopath Vaccination Information & Choice Network, Nevada City CA & Wales UK $$ Donations to help in the work - accepted by Paypal account vaccineinfo@... voicemail US 530-740-0561 (go to http://www.paypal.com) or by mail Vaccines - http://www.nccn.net/~wwithin/vaccine.htm Vaccine Dangers On-Line course - http://www.nccn.net/~wwithin/vaccineclass.htm Homeopathy On-Line course - http://www.nccn.net/~wwithin/homeo.htm ANY INFO OBTAINED HERE NOT TO BE CONSTRUED AS MEDICAL OR LEGAL ADVICE. THE DECISION TO VACCINATE IS YOURS AND YOURS ALONE. ****** " Just look at us. Everything is backwards; everything is upside down. Doctors destroy health, lawyers destroy justice, universities destroy knowledge, governments destroy freedom, the major media destroy information and religions destroy spirituality " .... Ellner Quote Link to comment Share on other sites More sharing options...
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