The Hawaii Vaccine Exemption form is a document that allows parents or guardians to formally refuse vaccinations for their children based on personal beliefs or religious tenets. This exemption is recognized under specific Hawaii laws, which outline the conditions under which a child may be exempted from required immunizations. Understanding the implications of this form is crucial for those considering opting out of vaccinations for their children.
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The Hawaii Vaccine Exemption form is a crucial document for parents who wish to exempt their children from mandatory vaccinations based on religious beliefs or medical conditions. This form allows parents or guardians to formally declare their refusal of vaccinations, citing their bona fide religious tenets and personal beliefs. It is essential to understand that while this exemption can be granted, it is not absolute. If the Department of Health determines there is a risk of an outbreak or epidemic, the exemption may not be recognized, and unvaccinated children could be excluded from school until the threat subsides. The form requires the parent or guardian's signature and includes spaces for the child's name, date of birth, school, and grade. It also references specific Hawaii Revised Statutes and Administrative Rules that outline the legal framework for vaccine exemptions, emphasizing the importance of informed decision-making regarding vaccinations. Parents are encouraged to educate themselves about the potential risks and benefits associated with vaccinations and childhood diseases, as well as the implications of their choices on their child's health and education.
State of Hawaii Vaccine Exemption
Pursuant to:
Hawaii Administrative Rules §11-157-5
Hawaii Revised Statues §302A-1156, §302A-1157, §325-0034
I understand that all children are susceptible to diseases, even if they are vaccinated for that particular disease. I understand that, according to the CDC vaccination does NOT provide immunity, and therefore my child could contract the disease, even if vaccinated.
Furthermore, I understand that there is significant risk involved with vaccination and that many children have become seriously injured, sometimes resulting in death, as a direct result of the vaccination. VAERS (Vaccine Adverse Event Reporting System) was specifically created by the government to handle the large number of people that have died or received serious injury from vaccination.
I understand that some advocates of vaccination (usually ones with a vested financial interest) report that vaccination can help prevent certain diseases. However, I do not believe the reported benefits outweigh the confirmed danger and risks inherit with vaccination.
If at any time there is, in the opinion of the Department of Health, danger of an outbreak or epidemic from any communicable disease for which vaccination is required, this exemption from vaccination shall not be recognized. As a result, my child will NOT be vaccinated, but will be excluded from school until the threat of an epidemic is over.
VACCINE REFUSAL FORM
I,____________________________, as the parent, guardian or person in loco parentis of
(insert your name)
the child _________________________, do hereby certify that the administration of any
(insert your child’s name)
vaccine or other “so called” immunizing agents is contrary to our bona fide religious
tenets and practices and our personal beliefs. In Summary, I directly forbid any and all
parties, public or private, to administer any form of vaccination to my child.
This is pursuant to my right to refuse vaccination based on Hawaii State Law (see
§302A-1156, §302A-1157, §325-0034 and HAR §11-157-5). Pursuant to Hawaii statutes I am providing a copy of this statement to our child’s school administrator or operator of the child’s group program.
Pupil’s Name:_________________________________
Date of Birth:______________
School:______________________________________
Grade:____________________
Parent/Guardian Name (print) :_____________________________________________________
Parent/Guardian Signature:________________________________________________________
Date:_________________________
http://www.capitol.hawaii.gov/hrscurrent/Vol05_Ch0261-0319/HRS0302A/HRS_0302A-1156.htm [§302A-1156] Exemptions A child may be exempted from the required immunizations:
(1)If a licensed physician certifies that the physical condition of the child is such that immunizations would endanger the child's life or health; or
(2)If any parent, custodian, guardian, or any other person in loco parentis to a child objects to immunization in writing on the grounds that the immunization conflicts with that person's bona fide religious tenets and practices. Upon showing the appropriate school official satisfactory evidence of the exemption, no certificate or other evidence of immunization shall be required for entry into school. [L 1996, c 89, pt of §2]
http://www.capitol.hawaii.gov/hrscurrent/Vol05_Ch0261-0319/HRS0302A/HRS_0302A-1157.htm [§302A-1157] Exemptions from immunization; not recognized; epidemic conditions.
If at any time there is, in the opinion of the department of health, danger of an epidemic from any of the communicable diseases for which immunization is required under sections 302A-1154 to 302A-1163, no exemption from immunization against the disease shall be recognized. Quarantine shall be a legal alternative to immunization. [L 1996, c 89, pt of §2]
http://www.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0325/HRS_0325-0034.htm [§325-34] Exemptions.
Section 325-32 shall be construed not to require the vaccination or immunization of any person for three months after a duly licensed physician or an authorized representative of the department of health has signed two copies of a certificate stating the name and address of the person and that because of a stated cause the health of the person would be endangered by the vaccination or immunization, and has forwarded the original copy of the certificate to the person or, if the person is a minor or under guardianship, to the person's parent or guardian, and has forwarded the duplicate copy of the certificate to the department for its files.
No person shall be subjected to vaccination, revaccination or immunization, who shall in writing object thereto on the grounds that the requirements are not in accordance with the religious tenets of an established church of which the person is a member or adherent, or, if the person is a minor or under guardianship, whose parent or guardian shall in writing object thereto on such grounds, but no objection shall be recognized when, in the opinion of the director of health, there is danger of an epidemic from any communicable disease.
http://gen.doh.hawaii.gov/sites/har/AdmRules1/11-157.pdf [§11-157-5] Exemptions.
(a)Medical exemptions from the requirements for specific immunizing agents shall be granted upon certification by a physician on the physician’s professional stationery that an immunization is medically contraindicated for a specific period of time. The original certificate shall be provided to the exempt person or parent or guardian. A copy of the certificate shall be maintained in the student’s school health record. Reports of such certificates shall be submitted to the department by each school.
(b)A religious exemption shall be granted to a student whose parent, custodian, guardian, or other person in loco parentis certifies that the person’s religious beliefs prohibit the practice of immunization. Requests for religious exemptions based on objections to specific immunizing agents will not be granted. Students who have reached the age of majority shall apply on their own behalf. The certification shall be retained in the student’s health record. Reports of such exemptions shall be submitted to the department by each school.
(c)If at any time, the director determines that there is the danger or presence of an outbreak or epidemic from any of the communicable diseases for which immunization is required under this chapter, the exemption from immunization against such disease shall not be recognized and inadequately immunized students shall be excluded from school until the director has determined that the presence or danger of the outbreak or epidemic no longer exists.
Making Informed Decisions
Your decision to vaccinate or not should be an informed decision. Vaccines can cause severe injuries such as seizures, death, anaphylaxis, brain damage and other reactions. The type and severity of reactions may vary from vaccine to vaccine and child to child. The effects of a vaccine injury may be temporary or permanent. If you notice any changes in your child’s condition after receiving a vaccine, you should contact your doctor immediately or go to a hospital. Vaccines have never been proven to be safe or effective and your child may contract the disease even if he is vaccinated. What has been proven is that you can get the disease from the vaccine or from coming into contact with a recently vaccinated person. The polio vaccine is just one example. It is a known fact that most healthcare providers do not fully inform patients of the side effects a vaccine can have on the body, brain and immune system. Because of the highly toxic ingredients all vaccines contain, you should thoroughly research vaccines for yourself before making such an important decision. DO NOT allow someone else, even your healthcare provider, scare or force you into making this decision without being fully informed. Many healthcare providers have not researched vaccine history or toxicology and are not fully informed. Always provide a detailed history of your child’s health to your doctor. Make sure they know of allergies, neurological problems, nutritional deficiencies, any immune system disorder and skin diseases such as eczema. Most physicians and nurses do not warn parents that if their child’s health is compromised in any way, such as having a common cold or previous reaction to a vaccine, they should not receive vaccines.
Benefits of Non-Vaccination
When you choose to not vaccinate your child, you have the responsibility to educate yourself on how to maintain the well-being of not only their body but also their mind and spirit as well. Childhood diseases can result in minor symptoms to severe complication or death depending on the child’s immune system and treatment protocols followed. The stronger the immune system, the less severe are the symptoms of the disease. A child that goes through the full expression of the disease (i.e. fever and skin eruptions, without suppressing any of these symptoms) usually acquires immunity from that disease for life. Good nutrition and cleanliness play a major role. The risk of contracting various diseases can vary over time or locality. Symptoms or complications of these diseases may be treatable by alternative methods or may resolve without treatment. Educate yourself on childhood diseases from informed alternative sources. Fear of these diseases comes from not being properly informed.
For More Information
To make a truly informed decision there are numerous sources of information on the risks of vaccines and the risks and benefits of childhood diseases. Sources of information to determine if the risks associated with vaccines outweigh any perceived benefits include: vaccine package inserts, the Physicians Desk Reference, the U.S. Center for Disease Control and Prevention, public and medical libraries or state and local health agencies. (NOTE: These sources do not give complete and total information on vaccine ingredients and their toxicity, nor do they provide accurate statistics.)
Vaccination Liberation – www.vaclib.org or (888) 249-1421
National Vaccine Information Center – www.909shot.com or (800) 909-SHOT / (703) 938-0324
(NOTE: The two websites above, Vaccination Liberation and the National Vaccine Information Center, have proven to be excellent sources for extensive vaccine information.)
Reporting Reactions
If you do decide to vaccinate, report vaccine reactions to:
Vaccine Adverse Event Reporting System (800) 822-7969
Always get the vaccine name, vaccine manufacturer and lot number. Keep records of day to day reactions from the time of vaccination for at least 6 months to 2 years, no matter how slight the reactions. Long-term effects of vaccines have not been well documented by the allopathic community and are just now being researched. If your child has been injured by a vaccine, he may be eligible for compensation under the National Vaccine Injury Compensation Program.
Revised 11/2008 Source:
A New Life Family Chiropractic
803 Kamehameha Hwy., Suite 301
Pearl City, HI 96782
This form may be reproduced
After completing the Hawaii Vaccine Exemption form, the next step is to submit it to your child's school administrator or the operator of your child's group program. Ensure that you keep a copy for your records. This form allows you to formally express your decision regarding vaccinations based on your personal beliefs or religious tenets.
The Hawaii Vaccine Exemption form allows parents or guardians to formally refuse vaccinations for their children based on personal beliefs or religious tenets. This form serves as a written declaration that vaccination is contrary to the beliefs of the parent or guardian, and it is submitted to the child's school or group program to ensure that the child can attend without being vaccinated.
Any parent, guardian, or person in loco parentis can use the Vaccine Exemption form for a child. The form can be utilized if the parent or guardian objects to immunization on the grounds that it conflicts with their bona fide religious beliefs or personal beliefs. It is important to note that the exemption is not recognized during an outbreak or epidemic of a communicable disease, as determined by the Department of Health.
If your child is exempted from vaccinations, you must provide the completed Vaccine Exemption form to the school administrator or operator of the child’s group program. The school will then maintain this documentation in the child's health record. Additionally, be prepared for the possibility that your child may be excluded from school during an outbreak of a communicable disease.
Yes, you can change your mind regarding the vaccination status of your child at any time. If you decide to have your child vaccinated after initially submitting the Vaccine Exemption form, you should notify the school or group program of this change. It is also advisable to keep records of any vaccinations received to update the child's health record accordingly.
For more information about vaccinations and the exemption process in Hawaii, you can visit the following resources: the Hawaii Department of Health website, the Centers for Disease Control and Prevention (CDC), and the National Vaccine Information Center. These sources provide comprehensive information on vaccine risks, benefits, and the exemption process. Always make sure to consult multiple sources to make an informed decision.
Failing to provide accurate personal information. It is essential to fill in the child's name, date of birth, and school accurately. Any discrepancies can delay the exemption process.
Not including a signature. The form requires a parent or guardian's signature to validate the request. Omitting this step renders the form incomplete.
Neglecting to state religious beliefs clearly. The exemption must articulate that the refusal is based on bona fide religious tenets. Vague statements may lead to rejection.
Submitting the form late. Timely submission is crucial. Delays may result in the child being excluded from school until the exemption is processed.
Overlooking the need for documentation. It is advisable to attach any supporting documents that validate the religious beliefs or health concerns stated in the exemption form.
Not understanding the implications of the exemption. Parents should be aware that their child may be excluded from school during outbreaks of communicable diseases, as per health department guidelines.
The Hawaii Vaccine Exemption form is a critical document for parents seeking to exempt their children from mandatory vaccinations due to medical or religious reasons. Alongside this form, several other documents often accompany the exemption process. Each of these documents plays a distinct role in ensuring compliance with state laws while protecting the rights of parents and guardians.
Understanding these accompanying documents can empower parents to navigate the exemption process effectively. Each form serves a unique purpose and contributes to the overall goal of safeguarding children's health while respecting individual rights and beliefs.
The Medical Exemption Form is similar to the Hawaii Vaccine Exemption Form in that it allows parents to opt-out of vaccinations for their children based on medical reasons. This form requires certification from a licensed physician, who must attest that administering vaccines would pose a significant risk to the child's health. Just as the Hawaii Vaccine Exemption Form emphasizes the importance of informed decision-making regarding vaccinations, the Medical Exemption Form also highlights the need for medical documentation to support the exemption request. Both forms serve to protect the health and well-being of children while adhering to state regulations.
The Religious Exemption Form shares similarities with the Hawaii Vaccine Exemption Form in its focus on personal beliefs. This form allows parents to refuse vaccinations for their children based on bona fide religious tenets. Just like the Hawaii form, it requires a written statement that articulates the religious objections to immunization. Both forms emphasize the importance of individual rights and beliefs in the context of public health, allowing parents to make choices that align with their values while navigating school requirements.
The Personal Belief Exemption Form is akin to the Hawaii Vaccine Exemption Form as it permits parents to decline vaccinations based on personal beliefs that are not necessarily religious in nature. This form requires a written declaration, similar to the Hawaii form, that outlines the reasons for the refusal. Both documents empower parents to make informed choices regarding their children's health, reflecting a growing trend towards individual autonomy in health-related decisions.
The Consent Form for Vaccination Refusal is another document that parallels the Hawaii Vaccine Exemption Form. This form requires parents to formally state their refusal to allow vaccinations for their child, often including a disclaimer about understanding the potential risks associated with not vaccinating. Much like the Hawaii form, it serves as a record of the parents' decision and their acknowledgment of the consequences, reinforcing the importance of informed consent in healthcare.
The School Health Exemption Form also bears similarities to the Hawaii Vaccine Exemption Form. This document is used by parents to exempt their children from vaccination requirements based on health, religious, or personal beliefs. It typically requires submission to school officials, ensuring that the exemption is recognized within the educational system. Both forms aim to maintain compliance with state laws while respecting the individual choices of families regarding vaccinations.
Finally, the State Health Department Exemption Request Form aligns closely with the Hawaii Vaccine Exemption Form. This form is submitted to state health authorities to request an exemption from vaccination requirements. It often requires detailed information about the child's health and the reasons for the exemption. Both forms highlight the necessity of following state guidelines while allowing families the opportunity to express their concerns and beliefs regarding vaccinations.
When filling out the Hawaii Vaccine Exemption form, it is important to approach the process with care and consideration. Here are eight essential tips to guide you through this important task:
By following these guidelines, you can help ensure that your request for a vaccine exemption is processed smoothly and effectively.
Understanding the Hawaii Vaccine Exemption form is crucial for parents considering opting out of vaccinations for their children. Here are some key takeaways to keep in mind:
By keeping these points in mind, parents can navigate the process of filling out and using the Hawaii Vaccine Exemption form with greater confidence and clarity.