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Discussion Starter #1
Hi all,<br><br>
Does anyone know where I can find a religious exemption form for PA that I can just print out and sign, or whatever I need to do? I have a WIC apt. on Fri., and they want a vax record. We're not vaxing, so I guess we should take the form. Also, DS's 2-mo. apt. is coming up in a few weeks, and I think they vax then. We refused Hep B in the hospital and they didn't like it, but let us go without the form, though we signed a waiver. Anyway, I'd appreciate it if I could find the form with this tight deadline.<br><br>
Thanks!
 

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<div>Originally Posted by <strong>mrskennedy</strong> <a href="/community/forum/post/7916507"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Hi all,<br><br>
Does anyone know where I can find a religious exemption form for PA that I</div>
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You do not need any vaccine record for WIC. They simply want two forms of identification and use the vaccine form as one.<br><br><b>Immunization status cannot be used as a condition of eligibiltiy for WIC.</b><br><br><a href="http://www.fns.usda.gov/wic/benefitsandservices/immunization.HTM" target="_blank">http://www.fns.usda.gov/wic/benefits...munization.HTM</a><br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">We're not vaxing, so I guess we should take the form.</td>
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There is no vaccine law anywhere in the US, so you do not need any form until your child goes to day care or school.<br>
Take two other forms of ID to WIC.<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Also, DS's 2-mo. apt. is coming up in a few weeks, and I think they vax then.</td>
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They vax every time you have a doctors appointment. That is the purpose of wbv.<br><br><br>
For Pennsylvania schools or day care -<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;"><b>To whom it may concern:<br><br>
In accordance with the provisions of Pennsylvania Code §§ 23.84, I hereby affirm that the administration of vaccines, immunizing agents, and PPD tuberculin skin testing to my child, NAME, is contrary to our personal religious<br>
beliefs.<br><br>
PA Code §§23.84 states the following:<br><br>
(b) Religious exemption. Children need not be immunized if the parent, guardian or emancipated child objects in writing to the immunization on religious grounds or on the basis of a strong moral or ethical conviction similar to a religious belief.<br><br>
Sincerely,<br><br>
YOUR NAME</b></td>
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It does not need to be notarized but doesn't hurt.<br><br><br><a href="http://www.vaclib.org/exempt/pennsylvania.htm" target="_blank">http://www.vaclib.org/exempt/pennsylvania.htm</a>
 

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Your doctor may hand you a form to sign. I would not use his form but instead have this one ready and filled out.<br><br>
They just want something in their files.<br><br><br>
You can copy and past to a sheet of paper. The format or text can be changed to fit your child.<br><br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Consent Declined for Vaccines<br><br><br>
Child’s Name ____________________________________Child’s ID___________________<br><br>
Parent’s Name______________________________________________ ____<br><br>
My child’s health care provider, ____________________________, has advised me that my child (named above) should receive the following vaccines:<br><br>
Recommended /Declined<br>
☐ Hepatitis B vaccine ☐<br>
☐ Diphtheria, Tetanus, acellular Pertussis (DTaP) vaccine☐<br>
☐ Diphtheria Tetanus (DT or dT) vaccine☐<br>
☐ Haemophilus influenzae type B (Hib) vaccine ☐<br>
☐ Pneumococcal conjugate vaccine ☐<br>
☐ Polio vaccine (IPV) ☐<br>
☐ Measles, mumps, rubella (MMR) vaccine ☐<br>
☐ Varicella (chickenpox) vaccine ☐<br>
☐ Influenza (flu) vaccine ☐<br>
☐ Meningococcal vaccine ☐<br>
☐ Hepatitis A vaccine ☐<br>
☐ Other ____________________________________☐<br><br>
I have read the Centers for Disease Control and Prevention’s Vaccine Information Sheet(s) explaining the vaccine(s) and the disease(s) it prevents. I have had the opportunity to discuss this with my child’s health care provider, who has answered all of my questions regarding the<br>
recommended vaccine(s).<br><br>
I understand the following:<br><br>
The intended purpose of and the need for the recommended vaccine(s).<br>
The risks and benefits of the recommended vaccine(s).<br>
If my child does not receive the vaccine(s), the consequences may include<br>
- Contracting the illness the vaccine should prevent.<br>
- Transmitting the disease to others.<br>
- The need for my child to stay out of child care or school during disease<br>
outbreaks.<br><br>
If my child does receive the vaccine(s), the consequences may include:<br>
-contracting the illness the vaccine should have prevented<br>
-transmitting the disease to others<br>
-suffering from any of the adverse events listed in the package insert and possibly adverse events not yet listed and/or associated with the vaccine.<br>
-chronic illness and/or death<br><br>
My health care provider, the American Academy of Pediatrics, the American Academy of Family Physicians, and the Centers for Disease Control and Prevention have all strongly recommended that the vaccine(s) be given based on the information they have been given by the drug companies<br>
producing the vaccines.<br><br>
I have declined consent for the vaccine(s) recommended for my child, as indicated above, by checking the appropriate box under the column titled “Declined”.<br><br>
I know that I may re-address this issue with my health care provider at any time, and that I may change my mind as personal beliefs are subject to evolve and change over time.<br><br>
I acknowledge that I have read this document in its entirety and fully understand it.<br><br><br>
Parent/Guardian Signature<br><br>
______________________________________Date________ __________<br><br><br><br>
Witness___________________________________________ __________<br><br>
Date__________________</td>
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Here's what the PA exemption portion of the immunization certificate looks like: <a href="http://staff.wcasd.k12.pa.us/teachers/vbabinecz/immunization_information.htm" target="_blank">http://staff.wcasd.k12.pa.us/teacher...nformation.htm</a><br><br>
A local school or health department should have the form.<br><br>
Based on what other PA mama's are telling me, they're starting to crack down on requiring an explanation. For the section where it states "reason," you can put something simple like:<br><br><i>We rely on our faith in God in order to prevent disease</i>
 

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We wrote a letter similar to the one Gitti posted when enrolling my daughter for K last spring. The nurse barely even blinked.<br><br>
They gave me more grief about not providing her social security number!
 

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Discussion Starter #6
Thanks for all your help! I have a form like the one listing the vaxes with boxes for recommending/declining them, as well as a letter explaining our religious beliefs with scriptures, citing the PA exemption information, and also citing public laws passed by Congress. Will this be enough for the ped? Also, we were involved with Children's Services b/c of other family members, and CPS was concerned about DS having contact with them. They want DS's medical records, and I signed a release form. However, I'm wondering if this will also be enough to keep CPS from trying to say we're neglecting DS for not vaxing. Obviously, we don't want any more trouble, and people have told me we'll have to vax him if we don't want him taken away. I know how horrible vaxes are and also that the exemption is legal. But is this enough?<br><br>
Thanks again.
 
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