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Vaccination Exemptions
Wisconsin
State Exemption Page
VacLib.org & VaccineTruth.net Exemption Page

Statutes/L A W S
Wisconsin State specific information

Link to state law.
National Vaccine Information Center:
NVIC link to state law.


For additional help with exemptions, birth plan, etc questions:
Check our Vaccination Liberation State Chapter and other resource organizations located in your state.

If your state specific help is not available, Contact us.


- - - Available Exemptions - - -
Medical  &  Religious  &  Philosophical/Other


§ 252.04(3) The immunization requirement is waived if the student, if an adult, or the students parent, guardian or legal custodian submits a written statement to the school, day care center or nursery school objecting to the immunization for reasons of health, religion or personal conviction. At the time any school, day care center or nursery school notifies a student, parent, guardian or legal custodian of the immunization requirements, it shall inform the person in writing of the person's right to a waiver under this subsection.


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Should Any Vaccines Be Required for Children?
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History of Vaccines

Table of State Vaccination Exemptions for Children Entering Public Schools

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Begin New Born Birthing Plan and Birth Exemptions
Wisconsin State specific New Born Exemption Information.
None at this time.


NewBorn Birthing Plan CONTINUED  [GENERAL INFORMATION APPLIES TO MOST STATES.]

BirthExemptions  |   Birthing_Plans  |   Vitamin_K  |   Hepatitis_B  |   Eyedrops  |   Newborn_Screening

Birth Exemptions:

For those who are planning a hospital birth but want to evade invasive routine post natal procedures such as a Hep B shot, vitamin K injection, newborn screening, or the application of silver nitrate in the newborn's eyes, a very specific birthing plan must be submitted to the hospital in advance of the birth. Hospital staff must be informed, in advance, of your needs, wants and desires where your baby and birthing experience are concerned. The same applies to midwives.

Steps:



  • Create the Birthplan. Or modify one of our ours to fit your state laws and any other personal circumstances. (see below)
  • Sign the birthplan in front of a Notary.
  • Submit the birth plan to your hospital or midwife. Keep a couple extra copies in case plans change.
  • Make sure affected parties (doctors, nurses, etc) understand your requirements and wishes.
  • Plan on having one or two trusted persons stay with the mother and child to watch the child at all times while in the hospital, so no unwanted injections are given the baby.
  • The birth plan arrangements and letter should be turned in before delivery date.
  • The "Refusal to Permit Medical Treatment" form below is optional.
  • The "Refusal to Register Live Birth" form below is also optional.



Wisconsin State specific information Birth Plans
None at this time.


Birth Plans GENERAL INFORMATION
(To be used with hospitals and/or midwives)


(Links to model birth plan letters)

Model Birth Plan Letter for Hospital Births. You can attach an exemption from immunizations. In some states, there are religious exemptions from newborn screening tests such as PKU, etc...



Information on the Dangers of Hospital Birth and the Benefits of Home Birth from gentlebirth.org

Our best and most itemized birthplan:
Word-Document (.doc) birthplan-itemized.doc  |   PDF-Document (.pdf) birthplan-itemized.pdf

(HTML) BirthPlan-Itemized for reading on screen. Includes handy small dictionary of terms in the document.

Word-Document (.doc) Model Letter for Hospital Births (Model11425.doc)

Model Birth Plan Letter for Hospital Births. This one is more detailed.

Word-Document (.doc) Model letter for hospital births 2.doc (11426)

Model Birth Plan Letter for Hospital Births for an adopted child...
Model letter for hospital births for adoptions -- Dear Doctor and Medical Staff.doc (11427)
Word-Document (.doc) Model letter for hospital births for adoptions.doc


The birth plan arrangements and letter should be turned in before delivery date.
This "Refusal to Permit Medical Treatment" form below is optional.




Wisconsin State specific information Medical Treatment Refusal
None at this time.


GENERAL INFORMATION (Medical Refusal Forms and Affidavit)




"Refusal to Permit Medical Treatment" form
A generic form.
PDF-file (.pdf) letters/refusal_treatment.pdf


It would be good idea to use the AFFIDAVIT below AND a model birth plan letter from above above.
Affidavit - Birth Exemptions
HTML (simple text) Affidavit to modify.

AFFIDAVIT in Microsoft Word Word-Document (.doc) format. (may be modified)

If your Title and Paragraph number of your state law is not pasted to the left, click here for the link to your state law.

Affidavit: Definition and some terms.




Wisconsin State specific information Vitamin K
None at this time.

Summary:

1. Make an informed choice as far ahead of birth as possible.

2. See the Black box warning in the FDA Package Insert for the Injection.

3. Know your options: Pre-Birth Diet, Oral Vitamin K, or synthetic Vitamin K Injection.


GENERAL INFORMATION
Vitamin K



Vitamin K Injection...

The Question of Vitamin K for Newborns
"Essentially all human infants are born with very low blood levels of vitamin K and, since low amounts of vitamin K crosses into breast milk, levels remain low for several weeks after birth in breastfed babies. The purpose of this natural, universal experience of low vitamin K levels in newborns is not known. ..."
"Mouse and epidemiologic studies indicate that the neonatal “deficiency” of vitamin K, which promotes cell turnover, may actually protect the developing fetus from damaging substances that “escape the primary placental screen.”
Read the rest of the article here:
http://www.thevaccinereaction.org/

The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert.

Warning

"The injectable form of vitamin K can rarely cause severe (sometimes fatal) allergic reactions when given by injection into a muscle or vein. Therefore, vitamin K should be injected into a muscle or vein only when it cannot be given by injection under the skin or taken by mouth, or when your doctor has judged that the benefit is greater than the risk. Seek immediate medical attention if you experience symptoms of an allergic reaction such as rash, itching, swelling, dizziness, or trouble breathing."
Potential exists for the newborn to experience hypersensitivity to any component of this medication.
Each milliliter contains: Phytonadione .. 2 mg or 10 mg
Inactive ingredients:
Polyoxyethylated fatty acid derivative .... 70 mg
Dextrose................................... 37.5 mg
Water for Injection, q.s. .................. 1 mL
Added as preservative: Benzyl alcohol .... 0.9%

Links to prescribing information for Vitamin K:
AquaMEPHYTON - FDA [PDF] 2002 PDF

http://vaclib.org/

Archive: Year 2002 Merck Vitamin K Package Insert - Aquamephyton PI | posted on Scribd

My daughter's Vitamin K injection injury Chairwoman and all ...
One Woman's experience: [PDF]

Alternatives to Vitamin K Prophylaxis...

Although oral vitamin K is not licensed for use as a drug by the FDA, drops for oral administration are available. Typically, one drop contains 2 mg. of vitamin K. Contact a midwife in your area, or a birthing supply company (such as birthwithlove.com), or Scientific Botanicals (206 527-5521) where your health care provider can order liquid vitamin K directly.

Here's another much safer alternative that your chiropractor or naturopath can order for you.

http://www.bioticsresearch
.com/Products/BioK.htm


Or buy direct from Amazon.com:

Good article with links to sources of oral and natural vitamin K
http://www.thehealthyhomeeconomist.com/oral-vitamin-k-better-vitamin-k-shot/

A good organic whole food diet along with lots of leafy green vegetables is all that is necessary to prevent vitamin K deficiency in newborns.

More Information:
Daily Med - Package Insert:
http://dailymed.nlm.nih.gov/

VRM: First Strike – The Dark Side of The Vitamin K Shot
http://vaccineresistancemovement.org/?p=6547

Informed Consent Defense (2020 Pilot Survey)
Wonderful Graphs comparing various unvaccinated vs vaccinated disease rates for vaccines and Vitamin K at birth PDF 4.8MB




Wisconsin State specific information Hepatitis B
None at this time.

Hepatitis B Vaccine




Most states now require the Hepatitis B vaccine for newborns. Many parents are also cornered by emergency room personnel during accident visits. Hospitals nationally are under pressure to utilize every opportunity to score a "hit." If your pediatrician understands your views, get him involved with the hospital. As a last resort, protect your right to receive quality care in by asking hospital personal to sign the following waiver. Usually, you'll never find anybody in the hospital to sign this simple form, but you well get relief from demands to vaccinate your child.

"I certify that the (Name of Vaccine)________ vaccine being administered to (Name of Child)_________ is free from all known and yet unknown zoonotic or human viruses or viral fragments and will not cause acute or chronic illness in the recipient due to viral contamination or as a reaction to the components of this vaccine. (Signature of Physician and Date)_________."

If you do get a signature, hold on to the form.

See Birth Plans for more information on avoiding Hep B Vaccination at birth




Wisconsin State specific information Eyedrops
None at this time.

Eyedrops: General





Some states require Prophylaxis against Gonococcal OPHTHALMIA NEONATORUM.

A discussion of medical and legal issues regarding Silver Nitrate in the eyes of the newborn is here:
PDF file: Statutory Law USA: Requiring Silver Nitrate in Eyes of Newborns at: http://www.rbs2.com/SilvNitr.pdf
Written by Dr. Ronald B. Standler, attorney in Massachusetts and consultant

Blog type discussion of pros and cons of eyedrops for newborn is here: http://answers.google.com/answers/threadview/id/20050.html





Wisconsin State specific information New Born Screening


Religious Exemption from newborn screening allowed.
Wis. Stat. Ann. § 253.13

Health Professionals Guide to Newborn Screening:
Newborn Screening Frequently Asked Questions (FAQs)
(.pdf) http://www.slh.wisc.edu/clinical/newborn/parents-guide-to-newborn-screening/frequently-asked-questions-faqs/
Can I say “no” to the test?
"Having your baby tested for these very serious conditions is important to the health of your baby. As a parent, you may refuse newborn blood screening for your baby only if your religious beliefs and practices or personal convictions do not agree with this testing."

Parents refusing under this condition should sign a statement that is placed in the infant's medical record.

Newborn Screening Statute WS 253.13 [Use TOC to get 253.13]
(3) Exceptions. This section shall not apply if the parents or legal guardian of the child object thereto on the grounds that the test conflicts with their religious tenets and practices or with their personal convictions. No tests may be performed under this section unless the parents or legal guardian are fully informed of the purposes of testing under this section and have been given reasonable opportunity to object as authorized in this subsection to such tests.

PDF Chapter 253, Matrnal and Child Health - see 253.13(3) (.pdf) http://www.legis.state.wi.us/statutes/Stat0253.pdf page 14.


Birth plan religious AFFIDAVIT text below. Use with model birth plan letter and/or refusal forms, and edit as needed...

AFFIDAVIT

I/We, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being(s), state Citizen(s) of the Wisconsin Republic affirm: Be it known to all courts, governments, and other parties that:

Being (a person/people) of Strong Christian Morals, it is against (my/our) Deep, Sincerely Held, Religious Convictions to accept the injection of any foreign substance into (my Body/our Bodies) or the Body of (my/our) Child. 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/our) newborn's body.

This written statement to exempt (my/our) newborn from any immunizations, newborn screening, and the Vitamin K shot, because (Iwe) hold genuine and sincere personal religious beliefs which are inconsistent with these medical procedures & experimentation. The practice of vaccination and the injection or application of any foreign substance is contrary to (my/our) conscientiously held religious beliefs and practices, and violates the free exercise of (my/our) religious principles.

The Hepatitis-B vaccine supposedly protects against a disease that is only transmitted through multiple sexual partners or street IV drug users and therefore usurps (my/our) parental authority to condemn such activity in (my/our) child. The acceptance of this vaccine promotes sexual promiscuity and immoral behavior in direct contradiction to the teachings of (my/our) faith.

The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert.
http://vaclib.org/chapter/inserts.htm#vitK
"WARNING - INTRAVENOUS USE Severe reactions, including fatalities, have occurred during and immediately after the parenteral administration of AquaMEPHYTON® (Phytonadione)."
A conflict arises because (my/our) religious convictions are predicated on the belief that all life is sacred. God's commandment "Thou Shall Not Kill" applies to the practice of injection of carcinogenic substances that can kill.

(We / I) {First and Last name(s)}, as the {(parent (s) /guardian(s)} of (name of newborn child) are exercising (our/my) rights under the First Amendment of the US Constitution , WS 253.13(3) and Wisconsin Statute § 252.04(3) to receive Religious Exemption from Vaccination, ALL injections, & 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.

Our legal rights are guaranteed by the free exercise clause of the First Amendment to the U.S. Constitution. Recent court decisions have upheld the rights of individuals seeking exemptions from immunizations based upon personal and religious reasons. On the U.S. Supreme Court level in Frazee V. Illinois Dept. of Security, 489 U.S. 829, it was found that a state may not deny an exemption simply because a person is not a member of a formal religious organization.

The Lord Jesus Christ and Our Creator are the only source of protection of (my body/our bodies) and that of (my/our) family that (I/we) can accept.

(I/We) affirm that vaccination & injections of any foreign substances and proteins conflict with (my/our) religious beliefs as stated above. Therefore, (I/we) would request that you accommodate (my/our) religious beliefs and practices by exempting (my/our) newborn child from any vaccinations, injections and testing of any kind.

Rest assured that (my family and I/our family) do practice a form of immunization that keeps our immune systems 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 Wisconsin

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___



New Born Screening: General




U.S. states now require screening of newborn babies for specific diseases.

Conditions and legal status of "requirement" of newborn to be screened for each state:
National Newborn Screening Status Report

Newborn Genetic Screening Privacy Laws
(includes links to laws for various states)
Archived Copy:

Newborn screening From Wikipedia, the free encyclopedia
en.wikipedia.org/

Federal NewBorn Screening Law
ncbi.nlm.nih.gov/


Page Navigation Links


Waivers: Read - Modify or Do Not Sign
Wisconsin State specific information Waivers
None at this time.

Waivers - Take Care In Signing
If you take your new baby to an MD as opposed to a naturopath and/or chiropractor, please be aware of and careful of any forms you sign.

Our WARNING below is about signing (some) state approved and AAP created forms. See this letter from our director, Ingri Cassel, before you consider signing waiver forms.



WARNING!

To ALL who choose to partially vaccinate or NOT vaccinate their children:

We (here in Idaho) are hearing more reports of schools and daycares across our state not honoring legal and valid vaccine exemptions. The following article contains very important information as to why you do NOT want to sign AAP's (state adopted) exemption form: http://childhealthsafety.wordpress.com/ ...

Filing a NO Vaccination Notice – for patients, employees and students (Your_Choice)

Older letter regarding exemptions in Idaho (similar to many states today)

Dear VacLib Members and Friends -

Wanted to give you all a heads up on state issued exemption forms. I haven't had to deal with this personally for several years, and I always crossed out sentences or clauses, and often adding some of my own, before signing their exemption of medical release type of forms. When Donna Carrillo began to diligently search out existing exemption forms and posting them, I read over a couple of them and encouraged people to make up their own whenever possible. After having a "closer encounter" with such a form - a form provided to the state of Idaho by the American Academy of Pediatrics and the Centers for Disease Control and Prevention and used by licensed Idaho daycares, I was shocked into the VERY REAL danger of signing these forms without changing them significantly.

Any form one affixes their initials to, dates and affixes their signature to at the end is a LEGAL document. All statements prior to your signature you must agree to fully OR restrict your signature to say that you are signing under TDC - threat, duress, and coercion. The form that my daughter was told she needed to fill out for this daycare is posted here: ChildCareExemptForm.pdf. On this form, she crossed out all the "nots" and in her personal statement she further clarified that she understands fully the risks of vaccinating her child.

I have since found out that most public schools and daycares in other states also use a similar form. Basically, by initialing and signing this form as is, you are admitting to understanding that "vaccine preventable" diseases are extremely deadly and ALSO admitting to negligence for willfully denying your son/daughter the life saving protection that vaccines offer. These forms are MEANT to not only be intimidating but to catch the legally ignorant off guard. This is very serious to me since all states have adopted the federally funded Child Abuse Prevention and Treatment Act which gives states the right to literally steal your children for up to 48 hours -- the time they have to prove child neglect OR abuse.

If it were ME, I would insist that they accept a form that I provide them since it satisfies the law. If there are any problems or they insist on me using their form, I would cite the law and ask the school or daycare provider where it actually says in state statute that this particular form is the only form that will satisfy the law. Since your parental rights are at stake here, it is best to be vigilant and err on the side of being overly cautious.


A modified AAP form is posted here that you may wish to use with your doctor: AAPmodified.htm

AAPmodified.doc MSWord .DOC file  |   AAPmodified.pdf PDF file, best for printing.

Not all State employees are aware of the law and many exhibit the Hitler Complex. Take a firm stand. Some individuals have had difficulty getting the required forms. Such arrogance on the part of State employees should be reported to the Director of your state Department of Health.

See:   AnaiRhoads.org [archive] Why Signing a Waiver to Avoid Vaccines Can Be Considered Abuse
She is referring to the Refusal To Vaccinate From developed by The American Academy of Pediatrics, not a regular religious or conscientious exemption letter or form.

Black's Law Dictionary - Sixth Edition - the definition of Affidavit. This is the dictionary used by the American Bar Association and all judges/magistrates/attorneys.

Affidavit - A written or printed declaration or statement of facts, made voluntarily, and confirmed by oath or affirmation of the party making it, taken before a person having authority to administer such oath or affirmation. [notary]

Warning: Any affidavit we supply is a suggestion or template for you to modify to fit your beliefs or understanding of facts. The "facts" are those of the person signing the affidavit.
Some definitions for terms on AFFIDAVIT:

Further Affiant Saith Not

Affiant: a person who makes an affidavit.

Saith: A third person singular present tense of say.

Sui Juris: having full legal capacity to act on one's own behalf : not subject to the authority of another

Propria Persona: In ones own proper person.


Page Navigation Links


Wisconsin State specific information LETTERS FORMS AFFIDAVITS
None at this time.

Letters Forms Affidavits (General)

Affidavit Index for all Ages: Affidavit Index



Links to Model birth plan letters (above).

Link to Refusal to Permit Medical Treatment form

Links to Affidavit - Birth

An Adult Affidavit, with Christian beliefs, is here. (MSDOC file) Feel free to modify as needed.

Dr. Tenpenny had the following forms on her web site. (Now Archived) The forms are generic and may be used in any state. Check any references that might need updating.

Affidavit for Parents Participating in International Adoption (Word) (pdf)
Hep B vaccine in hospital for newborn refusal, sample (pdf)
OSHA Declination Statement Form (also, pdf)
Religious exemption letter that was approved in Florida (Word) (pdf)
School Vaccine Exemption Form, sample (Word) (pdf)
TB testing refusal, sample (pdf)
Childcare and School Immunization Requirements

web.archive.org

Sample Vaccine Letters. from vaccines.bizland.com/letters.htm archived on VacLib.org/

Short Sample Vaccine Letter

Most states now require the Hepatitis B vaccine for newborns. Many parents are also cornered by emergency room personnel during accident visits. Hospitals nationally are under pressure to utilize every opportunity to score a "hit." If your pediatrician understands your views, get him involved with the hospital. As a last resort, protect your right to receive quality care in the following manner. (Usually, you'll never find anybody in the hospital to sign this simple form):

"I certify that the (Name of Vaccine)________ vaccine being administered to (Name of Child)_________ is free from all known and yet unknown zoonotic or human viruses or viral fragments and will not cause acute or chronic illness in the recipient due to viral contamination or as a reaction to the components of this vaccine. (Signature of Physician and Date)_________."

If you do get a signature, hold on to the form.

The ACCEPTANCE OF RESPONSIBILITY is imperative in exercising your rights for legal exemptions from forced medical experimentation and legalized bioterrorism. DO be prepared to fight for your baby's rights!
An index page to various Acceptance of Responsibility) forms is here:
. http://www.vaclib.org/legal/accept.htm

Religious exemption forms will be listed below under Daycare Schools Colleges

Did not find your state exemption form on our site?
Then try this link to forms for all 50 states and D. of Columbia.
experimentalvaccines.org/vaccine-exemption-forms/


Page Navigation Links

DayCare - Preschool - Schools - Colleges
Wisconsin State specific information

DayCare-Preschool-K-12-Colleges
State Form Required:   No

DayCare-Preschool-K-12-Colleges
DayCare  |   Preschool  |   K thru 12  |   Colleges

DayCare and Preschools

§ 252.04(3) The immunization requirement is waived if the student, if an adult, or the student's parent, guardian or legal custodian
submits a written statement to the school, day care center or nursery school objecting to the immunization for reasons of health, religion or personal conviction. At the time any school, day care center or nursery school notifies a student, parent, guardian or legal custodian of the immunization requirements, it shall inform the person in writing of the person's right to a waiver under this subsection.

The Wisconsin Student Immunization Record has a
check box for Religious reasons for exemption and another
check box for personal conviction exemption to vaccination. You can down load the the form here:
https://www.dhs.wisconsin.gov/forms/F0/F04020L.pdf
Check the appropriate box and submit the form to the facility or school and that should be all you need.



WISCONSIN STATUTE § 252.04(3)

§ 252.04(3) The immunization requirement is waived if the student, if an adult, or the student's parent, guardian or legal custodian submits a written statement to the school, day care center or nursery school objecting to the immunization for reasons of health, religion or personal conviction. At the time any school, day care center or nursery school notifies a student, parent, guardian or legal custodian of the immunization requirements, it shall inform the person in writing of the person's right to a waiver under this subsection.

If you would rather use a letter of your own, a Template -
(.doc) is here. VaccineTruth.net/letters/ExemptionVacLibWisconsin.doc

PDF version is here.


Kindergarten & Schools

§ 252.04(3) The immunization requirement is waived if the student, if an adult, or the student's parent, guardian or legal custodian submits a written statement to the school, day care center or nursery school objecting to the immunization for reasons of health, religion or personal conviction. At the time any school, day care center or nursery school notifies a student, parent, guardian or legal custodian of the immunization requirements, it shall inform the person in writing of the person's right to a waiver under this subsection.

The Wisconsin Student Immunization Record has a
check box for Religious reasons for exemption and another
check box for personal conviction exemption to vaccination. You can down load the the form here:
https://www.dhs.wisconsin.gov/forms/F0/F04020L.pdf
Check the appropriate box and submit the form to the facility or school and that should be all you need.


Colleges/Universities

§ 252.04(3) The immunization requirement is waived if the student, if an adult, or the student's parent, guardian or legal custodian submits a written statement to the school, day care center or nursery school objecting to the immunization for reasons of health, religion or personal conviction. At the time any school, day care center or nursery school notifies a student, parent, guardian or legal custodian of the immunization requirements, it shall inform the person in writing of the person's right to a waiver under this subsection.

CONCORDIA UNIVERSITY WISCONSIN School of Pharmacy
Immunization Declination Page 32
(.pdf) https://www.cuw.edu/academics/schools/pharmacy/_assets/student-handbook.pdf
Immunization Declination
Any student who wishes to decline a vaccination will be required to submit written documentation and rationale from a health care provider and/or religious leader stating that a previous severe allergic reaction or personal religious beliefs preclude the student from receiving the vaccine. This documentation must be provided annually and received by the Office of Experiential Education each year by September 1.

Students who choose to decline vaccinations may be prohibited from participating in experiential rotations at certain health systems due to policies and procedures in place at individual hospitals and pharmacies, even with documented rationale on file at CUWSOP.

LAKELAND COLLEGE
MENINGOCOCCAL VACCINE WAIVER
(.pdf) https://www.lakeland.edu/PDFs/HealthServices/new%20health%20forms%202013.pdf



These Google searches are mostly the college and school exemptions. There are always new forms coming online. Keep a regular check on these to look for newly added forms. Some are for daycare too. The links are the actual keywords that are used.

Google Search links:
Immunization Exemption Form

Vaccine Exemption Form

Immunization Waiver


Affidavit Index

An Adult Affidavit, with Christian beliefs, is Downloadable here. (MSDOC file) Feel free to modify as needed.

Index of Letters/Affidavit files.


Wisconsin State specific information for various Opt-Outs

Immunization Registry Opt-Out:

Information sheet:
https://www.cchfreedom.org/files/file/Wisconsin%20-%20Vaccination.pdf‎
Since 2000, every child born in the State of Wisconsin has been enrolled in the registry using information from the child’s birth certificate, unless the child’s legal guardian requests not to be enrolled.

Wisconsin Immunization Registry (WIR) is an opt out system.
Archived Information:
https://web.archive.org/web/20101126181627/http://prohealthcare.org/pdf/FAQs%2012-16-08.pdf
[FAQ] 11. Can I prevent my/my child’s health care provider(s) from sending immunization records?
Yes, you can prevent your health care provider(s) from sending immunization records in two separate ways:
a. Notify your health care provider that you do not want your/your child’s immunization records sent (ie, you are choosing to “opt-out”).
b. Notify the WIR that you do not want your/your child’s immunizations included in the registry. You can also complete the State’s form Wisconsin Immunization Registry Exclusion. This method is best if you visit multiple providers in the State of Wisconsin. WIR will block any health care provider from sending your immunization records to the registry.

Participating immunization providers are expected to inform the child’s parent, guardian or legal custodian that data may be transferred to the WIR and give the parent, guardian or legal custodian the opportunity to exclude the child from the registry or restrict access to the participating provider. The Vaccine Administration Record (DPH Form 4702), given at the time of immunization, can be used to provide this notice. This form may be ordered from the Wisconsin Immunization Program or printed directly from the WIR.
https://www.dhfswir.org/docs/Provider%20-%20WIR%20Security%20and%20Confidentiality%20Agreement.pdf

Re form 4702:
Information collected on this form will be used to document authorization for receipt of vaccine(s). Information may be shared through the Wisconsin Immunization Registry (WIR) with other health care providers directly involved with the patient to assure completion of the vaccine schedule. Information collected on this form is voluntary and the Social Security Number will be used by parent or guardian to access the Wisconsin Immunization Registry.
https://www.dhs.wisconsin.gov/forms/f4/f44702.pdf

Wisconsin Immunization Registry - form
View, Opt-Out, and Opt-Back In --- Form: Archived
Originally posted at: Pro Health Care Organization
https://web.archive.org/web/20101126181644/http://prohealthcare.org/pdf/WIR%20Form%20English%2012-17-08.pdf



OptOutRegistry for Vaccines
and various other Opt-Outs



Vaccine Registry Opt-Outs:

KNOW YOUR RIGHTS
Confidentiality of Your Child’s Vaccination Records
FERPA: The Family Educational Rights and Privacy Act
vaxchoicevt.com

     - - - - Other Opt-Outs - - - -:

Birth Certificate and Marriage License Opt-Out:

Did you know that you can REFUSE to sign the hospital birth certificates and that there is no law that requires you to do so?
See: Marriage Licenses, Birth Certificates & #SSNs

Military Recruiters:
Opt-Out For Children in public schools to to have information withheld from military recruiters.
https://nnomy.org/en/resources/counter-recruitment/opt-out-student-lists.html


STUDENT OPT OUT FORM regarding the
RELEASE OF NAME, ADDRESS, AND TELEPHONE NUMBER TO MILITARY RECRUITERS
pdf file (.pdf) Archived letter from militaryfreeschools.org

UNDERGROUND ACTION ALLIANCE STUDENT OPT OUT FORM
Word-Document (.doc) Archived on VacLib.org: veterans4peace.org/opt_out.doc

SAMPLE ENGLISH - BILINGUAL FORMS FOR OPTING OUT
Act to Protect Your Privacy from Military Recruiters
Information links and booklets at AFSC site

STUDENT OPT-OUT NOTICE regarding the instruction of sexuality to children:
STUDENT OPT-OUT NOTICE Valid in all 50 states
PDF-file (.pdf) armenianchurchlibrary.com/files/national_opt-out.pdf

STUDENT OPT-OUT NOTICE - Google Search



Wisconsin State specific information Employment
Not at this time

General Employment

Suggestions for dealing with Employer Mandates.



OSHA
Standard Interpretations
09/23/1997 - The Bloodborne Pathogen Standard and the Enforcement Procedures for TB.
"Finally, be aware that participation in the employer's skin testing program is voluntary on the part of the employee. OSHA does not require that employees participate in TB skin testing, only that the employer make such skin testing available to employees."
See TB Testing for more information.

US Fish and Wildlife Service Form 3-2283
Hepatitis B Immunization Consent/Refusal Form
PDF-file (.pdf) ARCHIVED: http://www.fws.gov/forms/3-2283.pdf


Page Navigation Links


Wisconsin State specific information TB Testing

TB Test:

TB Test required at University of Wisconsin-La Crosse

TB Test required for
The Medical College of Wisconsin
8701 Watertown Plank Road
P.O. Box 26509
Milwaukee, WI 53226


School Employees:

Wisconsin Statute 118.25 (2) (b) Health examinations.

(b) Such physical examinations, chest X-rays, or tuberculin tests shall not be required of any school employee who files with the school board an affidavit setting forth that he depends exclusively upon prayer or spiritual means for healing in accordance with the teachings of a bona fide religious sect, denomination or organization and that he is to the best of his knowledge and belief in good health and that he claims exemption from health examination on these grounds. Notwithstanding the filing of such affidavit, if there is a reasonable cause to believe that such employee is suffering from an illness detrimental to the health of the pupils, the school board may require a health examination of such school employee sufficient to indicate whether or not such a school employee is suffering from such an illness. No school employee may be discriminated against by reason of his filing such affidavit.


General Information: TB and/or Lead Testing



OSHA
Standard Interpretations
09/23/1997 - The Bloodborne Pathogen Standard and the Enforcement Procedures for TB.
"Finally, be aware that participation in the employer's skin testing program is voluntary on the part of the employee. OSHA does not require that employees participate in TB skin testing, only that the employer make such skin testing available to employees."
Generic letter for Exemption to TB Testing:
HTML (text): Exemption-tb-test.html

MS Doc file: Exemption-tb-test.doc

TB and Lead Testing Links:
F L Y E R    LETTER    Exemption_Letters    OSHA_and_TB_test    Tubersol    Treatment    TB_Screening    Alternatives/Additional_Information

The above TB and Lead exemption letters are courtesy of Deirdre DeVane of Wash DC. Thank you Deirdre!
The adult TB letters were edited by Sherri Tenpenny. Thank you Sherri!

TB can be detected by biofeedback machines that are hooked up to a computer, such as the QXCI, Best BioMeridian MSAS (Meridian Stress Assessment) or Electro Dermal Screening, Quantum Life System, and the F-Scan. You will need to ask specifically for a pathogen scan, especially TB. You will also need to request a printout with the results.

Next (below) in Misc are some QXCI and other practitioners. (If known.)



Misc Info and explanation of QXCI - Etc.

QXCI SCIO EPFX Overview



(The SCIO and the EPFX are the same device.
It is known as the EPFX in the USA and the SCIO world wide.)
Source:
energymedicinereview.com/qxci-scio-epfx.html [Now inactive]

National (USA) search on business site for EPFX (QXCI) / SCIO Practitioners.
alternativesforhealing


Use Google or other search engine to find a BioMeridian Practitioner in your area.

If you do not find a practitioner, you can contact the current device manufacturer for the practitioner in your area.
ihtbio.com/support-and-help/


Wisconsin specific information Misc/QXCI

QXCI and BioMeridian providers in Wisconsin




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