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AFFIDAVIT DECLARATION OF VACCINATION EXEMPTION


Pursuant to Senate Bill # 942, Section 1 Chapter # 7, under the title "Exemption From Immunization," I hereby declare that I, as a guardian/parent having responsibility for my self/child, named _________________________________ who is an adult/minor, withhold my consent and let it be known that said adult/minor is exempt from any and all immunizations and/or vaccinations on the grounds that such is contrary to my personal and/or religious beliefs.


SENATE BILL #942, SECTION 1, CHAPTER 7
3380 - IN ENACTING THIS CHAPTER, IT IS THE INTENT OF THE LEGISLATURE TO PROVIDE: ... (C) EXEMPTION FROM IMMUNIZATION FOR MEDICAL REASONS OR PERSONAL BELIEFS.


3385 - IMMUNIZATIONS OF A PERSON SHALL NOT BE REQUIRED FOR ADMISSION TO A SCHOOL OR OTHER INSTITUTION ... IF THE GUARDIAN, PARENT, OR ADULT WHO HAS ASSUMED RESPONSIBILITY FOR HIS OR HER CUSTODY AND CARE IN THE CASE OF A MINOR, OR THE PERSON SEEKING ADMISSION, FILES WITH THE GOVERNING AUTHORITY, A LETTER OR AFFIDAVIT STATING THAT SUCH VACCINATION IS CONTRARY TO HIS/HER BELIEFS ...
Any school or medical authority which tries to enforce vaccination on children or anyone else is in violation of the laws of the United States, and may be subject to prosecution.


Amendment 14 of the United States Constitution: "No state shall make or impose any law which shall abridge the privileges or immunities of the citizens of the United States, nor shall any state deprive any person of life, liberty, or property."
Amendment 4 of the United States Constitution: "The right of the people to be secure in their persons shall not be violated."

SUBSCRIBED AND AFFIRMED BEFORE ME ON THIS _____ TH DAY OF _______________, _________.


WITHOUT PREJUDICE UCC 1-207

_______________________________________________ SIGNATURE AND DATE


______________________________ NOTARY PUBLIC