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Old 11-16-2011, 11:11 AM   #1
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Refusal of Vaccination for My Child form help

I'm applying for a Religious exemption for my 4th child. They have changed proceedure and want me to sign a Refusal of Vaccination for My Child form, a Request for Religious Exemption form, and have it notarized.
I'm really struggling with signing the refusal form.
#1: Does anyone know if there is another way (state of Kentucky) to make this happen besides signing their Refusal of Vaccination form?
#2: Am I getting worked up over nothing?

Here are the bullet points on the Refusal form:

*I understand that some vaccine-preventable diseases are infecting unvaccinated US children, resulting in many hospitalizations and even deaths.
*I understand that though vaccination has led to a dramatic decline in the number of US cases of the diseases listed below, some of these diseases are quite common in other countries and can be brought to the US by international travelers. My child, if unvaccinated, could easily get one of these diseases while traveling or from a traveler.
*I understand that my unvaccinated child could spread disease to another child who is too young to be vaccinated or whose medical condition prevents them from being vaccinated. This could result in lont-term complications and even death for the other child.
*I understand that if every parent exempted their child from vaccination, these diseases would return to our community in full force.
*I understand taht my child may not be protected by "herd" or "community" immunity
*I understand that some vaccine-preventable diseases such as measles and pertussis are extremely infections and have been known to infect even the very few unvaccinated people living in highly vaccinated populations.
*I understand that if my child is not vaccinated and consequently becomes infected, he or she could experience serious consequences, such as amputation, pneumonia, hospitalization, brain damage, paralysis, meningitis, seizures, deafness, and death. Many children left intentionally unvaccinated have suffered severe health consequences from their parents' decisions not to vaccinate them.
*I understadn that my child may be excluded from his or her child care facility, school, sports events, or other organized activities during disease outbreaks. This means that I could miss many days of work to stay home with my child.
*I understand that the AAP, AAFP, and the CDC all clearly support preventing diseases through vaccination.



I'm also wondering if this is the same form that I was told to sign at our former pediatricians office 6 years ago. I remember being upset by that form as well, but did not feel there was anything I could do about it in that moment.
I am applying for the religious exemption in an honest manner and for honest reasons. I am very well educated on the risk factors both ways.
I do not, however, feel that I should be made to feel ashamed, scared, singled out, and that my children (who I make wise decisions to keep in optimal health) might be harming everyone around them by not being vaccinated. I feel this form is kind of a bully tactic.

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Old 11-16-2011, 11:14 AM   #2
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Re: Refusal of Vaccination for My Child form help

sorry for the typos above...
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Old 11-16-2011, 11:28 AM   #3
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Re: Refusal of Vaccination for My Child form help

Here is a link with other forms;
http://www.vaclib.org/exempt/kentucky.htm

Are you supposed to turn this into the health department? For school? Good for you not signing that form.... if you don't fully agree with every bullet point then don't sign it! They can't require you to sign something you don't fully agree with, provide them with another form.
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Old 11-16-2011, 11:45 AM   #4
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Re: Refusal of Vaccination for My Child form help

This is the form the Health Department says I must sign to request a religious exemption.
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Old 11-16-2011, 11:59 AM   #5
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Re: Refusal of Vaccination for My Child form help

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Originally Posted by chameleon607 View Post
This is the form the Health Department says I must sign to request a religious exemption.
You could probably offer your own form, or a variation of this form to them. Then let them know that you don't need to request permission to be religious. Religion is a right not a gift to be granted.

I'd probably change it to include the fact that all of those things also apply to immunized children as well. 'I'm signing that I know xyz applies to my child/ that is also applies to the immunized child' ' I understand that it is possible to spread germs without actually being sick, hence the pertussis out breaks in this immunized location.'
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Old 11-16-2011, 12:00 PM   #6
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Re: Refusal of Vaccination for My Child form help

Which sentence don't you agree with? Cross it out, initial it, explain the reason, and turn it in.
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Old 11-16-2011, 12:05 PM   #7
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Re: Refusal of Vaccination for My Child form help

Here's a link to your state's law;
http://www.lrc.state.ky.us/kar/902/002/060.htm


Section 3. Exceptions and Exemptions to the Immunization Schedules. (1) If the first two (2) doses of Hib vaccine required in Section 2(2) of this administrative regulation were meningococcal group B outer membrane protein (PRP-OMP) vaccines, the third dose may be omitted.

.................................omitted to save space..................

(7) A child with a medical contraindication to receiving a vaccine may obtain, from the child's healthcare provider, a "Certificate of Medical Exemption" from the requirements of Section 2 of this administrative regulation, in compliance with KRS 214.036.

(8)(a) A healthcare provider, pharmacist, local health department, or other licensed healthcare facility administering immunizations, shall, upon receipt of a written sworn statement from the parent or guardian of a child, issue a "Certificate of Religious Exemption" from the requirements of Section 2 of this administrative regulation, in compliance with KRS 214.036.

(b) A "Certificate of Religious Exemption" shall only be valid for all requirements of Section 2 of this administrative regulation.

(9)(a) A provisional immunization certificate shall be issued for an otherwise-qualified child, who is behind in required immunizations, and:

1. Who has not yet reached the required minimum age; or

2. For whom the time interval between doses has not elapsed.

(b) A provisional immunization certificate shall:

1. Permit a child to attend a child day care center, certified family child care home, other licensed facility which cares for children, preschool program, primary or secondary school until the child reaches the appropriate age, or upon passage of the time interval between required doses;

2. Expire fourteen (14) days from the date the next dose is required to be given; and

3. Not be valid for more than one (1) year.

Last edited by threelittlehoneys; 11-16-2011 at 12:09 PM.
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Old 11-16-2011, 12:05 PM   #8
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Re: Refusal of Vaccination for My Child form help

Here is a link to KRS 214.036;
http://www.lrc.ky.gov/KRS/214-00/036.PDF

They can say all they want that is has to be that form, but the law is not on their side.
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Old 11-16-2011, 12:05 PM   #9
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Re: Refusal of Vaccination for My Child form help

Quote:
Originally Posted by wlillie View Post
Which sentence don't you agree with? Cross it out, initial it, explain the reason, and turn it in.
I don't know anything about this because my son's only two - but I think this is good advice. We're planning on moving to KY within the next year or two - and I'll have to do the same forms... I was just planning on researching what's required in KY.

I wish I could be more helpful... But I can just say good luck, offer hugs and support!
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Old 11-16-2011, 12:18 PM   #10
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Re: Refusal of Vaccination for My Child form help

Quote:
Originally Posted by wlillie View Post
Which sentence don't you agree with? Cross it out, initial it, explain the reason, and turn it in.
The State of Kentucky is basically making sure that all parents who refuse on religious grounds recognize the risks associated with not vaccinating. Basically informed consent in reverse.
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