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In the state of Georgia, individuals have the legal right to seek an exemption from vaccination for their children on religious grounds, as outlined under the Official Code of Georgia Annotated § 20-2-771 4.(e). This provision allows parents or legal guardians who hold genuine religious beliefs opposing immunization to exempt their children from mandatory vaccinations required by schools or other facilities. To do so, they must furnish a signed affidavit to the school or facility's responsible official, declaring that the act of immunization contradicts their religious beliefs. The Ga Vaccine Exemption form serves as a critical tool in this process, allowing parents to formally certify their decision to refuse vaccinating their child due to religious convictions. This form must be presented to the child's school administrator along with an enumeration of specific vaccines being refused, underscoring the family's commitment to their beliefs. Additionally, the document touches on the importance of making an informed choice regarding vaccination, highlighting the potential risks associated with vaccines and advocating for personal research into their safety and efficacy. It also stresses the benefits of natural immunity, the importance of informed decision-making, and provides resources for further exploration into vaccination risks and alternatives. The form notably advises parents on the procedure for reporting adverse vaccine reactions and suggests that vaccine injuries may qualify for compensation under the National Vaccine Injury Compensation Program, facilitating a comprehensive approach to informed parental choice in the context of child immunization.

Form Sample

VACCINATION EXEMPTION PURSUANT TO THE

OFFICIAL CODE OF GEORGIA ANNOTATED § 20-2-771

4.(e) This Code section shall not apply to a child whose parent or legal guardian objects to immunization of the child on the grounds that the immunization conflicts with the religious beliefs of the parent or guardian; however, the immunization may be required in cases when such disease is in epidemic stages. For a child to be exempt from immunization on religious grounds, the parent or guardian must first furnish the responsible official of the school or facility an affidavit in which the parent or guardian swears or affirms that the immunization required conflicts with the religious beliefs of the parent or guardian.

________________________________________________________________________________

VACCINE EXEMPTION FORM

I,____________________________, as the parent, guardian or person in

(insert your name)

loco parentis of the child __________________________, hereby certify that the

(insert your child’s name)

administration of any vaccine or other immunizing agents is contrary to our religious beliefs.

Diphtheria

Measles

Other

Tetanus

Mumps

 

Pertussis

Rubella

 

Polio

Haemophilus influenzae type b

Hepatitis B

Varicella

 

Smallpox

Anthrax

 

This is pursuant to my right to refuse vaccination on the grounds that vaccinations conflict with my religious beliefs. Pursuant to Georgia statute I am providing a copy of this statement to our child’s school administrator or operator of the group program pursuant to

O.C.G.A. § 20-2-771 (4e).

Parent __________________________________ Date _______________

Parent __________________________________ Date _______________

Subscribed and Sworn before me this _____ day of ___________, 20____.

________________________________________

Notary's Signature and Seal

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 the 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.

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Revised 6/03 Source: Vaccination Liberation, P.O. Box 457, Spirit Lake, ID 83869

This form may be reproduced

File Overview

Fact Description
Governing Law Official Code of Georgia Annotated § 20-2-771 4.(e)
Exemption Basis Religious beliefs conflicting with immunization.
Requirement for Exemption Submission of an affidavit by the parent or guardian.
Form Usage To certify vaccination refusal due to religious beliefs.
Listed Diseases Diphtheria, Measles, Tetanus, Mumps, Pertussis, Rubella, Polio, Haemophilus influenzae type b, Hepatitis B, Varicella, Smallpox, Anthrax, among others.
Risks of Vaccination Possible severe injuries including seizures, death, anaphylaxis, and brain damage.
Educational Responsibility Parents choosing not to vaccinate are encouraged to educate themselves on maintaining their child's health.
Information Sources Vaccination Liberation, National Vaccine Information Center, CDC, and others for making an informed decision.

Guide to Using Ga Vaccine Exemption

Filling out the Georgia Vaccine Exemption form is crucial for parents or guardians who believe that immunizing their child conflicts with their religious beliefs. This document is necessary to formally declare the exemption for school records in accordance with Georgia law. Here are the steps to properly complete this form:

  1. Enter your full name where the form reads "I,____________________________," to identify yourself as the parent, guardian, or person in loco parentis.
  2. Insert your child’s full name where the form reads "(insert your child’s name)" to specify whose immunization is being exempted.
  3. Check the boxes next to the names of the vaccines you are refusing to administer to your child due to religious beliefs. The form lists several vaccines, including but not limited to Diphtheria, Measles, Tetanus, and Polio.
  4. Sign your name at the bottom of the form where it says "Parent" to certify your declaration.
  5. Date your signing of the form next to your signature.
  6. The form must be notarized, so present it to a notary public. Fill in the date and have the notary sign under "Subscribed and Sworn before me this _____ day of ___________, 20____."
  7. Remember to keep a copy of this form for your records. The original should be furnished to the responsible official of your child's school or group program as indicated by the statute.

Once you have completed and submitted the form, you have formally declared your religious exemption from vaccinating your child. It's important to understand the responsibilities and potential risks associated with this decision. Staying informed about how to maintain your child's health and being aware of symptoms or complications from childhood diseases will be crucial. Should you decide to vaccinate in the future, closely monitor your child's reaction and report any adverse events to the proper authorities.

Obtain Clarifications on Ga Vaccine Exemption

  1. What is the Georgia Vaccination Exemption Form?

    This form allows parents or legal guardians in Georgia to exempt their children from vaccinations required for school or group program enrollment on the basis of religious beliefs. It necessitates submitting an affidavit to the school or program's responsible official, declaring that immunizations conflict with their religious beliefs.

  2. How can I obtain the Georgia Vaccination Exemption Form?

    The form can be created based on the content provided in the Vaccination Exemption Section pursuant to the Official Code of Georgia Annotated § 20-2-771 4.(e). It is not a standardized form provided by the state but can be drafted as per the guidelines mentioned. It's advisable to contact your child's school or program administration for guidance on their specific requirements.

  3. What information is required on the form?

    The form requires the parent, guardian, or person in loco parentis to state their name, the child’s name, and affirm that immunizing the child is against their religious beliefs. Additionally, it must include a list of specific vaccines being exempted, the parents' or guardians’ signatures, and be notarized.

  4. Is notarization required for the Vaccine Exemption Form?

    Yes, after completing the form, it needs to be notarized. This involves signing the form in front of a Notary Public who will verify the identity of the signer and attest to the authenticity of the signature.

  5. Can the exemption be applied in case of an epidemic?

    The law specifies that immunizations may be required in cases when the disease is in 'epidemic stages' even if an exemption has been granted. This means that during a public health crisis, the exemption based on religious beliefs might not apply.

  6. How should parents or guardians submit the exemption affidavit?

    Parents or guardians must furnish a copy of the completed and notarized exemption affidavit to the responsible official of their child’s school or the operator of the group program. It's recommended to keep a copy for your records and confirm receipt with the school or program.

  7. What are the consequences of choosing not to vaccinate?

    Choosing not to vaccinate your child carries responsibilities such as educating yourself on maintaining their health and well-being. Non-vaccinated children may have a different risk profile for contracting diseases, and parents are encouraged to understand these risks fully as well as alternative prevention and treatment methods.

  8. Where can I find more information to make an informed decision?

    For those looking to make an informed decision, it's important to research from a variety of sources including vaccine package inserts, the Physicians Desk Reference, and the U.S. Center for Disease Control and Prevention. Additionally, organizations like Vaccination Liberation and the National Vaccine Information Center offer extensive information on vaccine risks and benefits.

Common mistakes

Filling out the Georgia Vaccine Exemption form may seem straightforward, but there are common mistakes that can hinder the process. Paying attention to detail and following instructions carefully can make a significant difference in successfully claiming an exemption for your child. Here are four missteps to avoid:

  1. Not properly identifying the relationship to the child: The form requires clarification on whether you are a parent, guardian, or acting in loco parentis. This distinction is crucial for establishing legal standing to make decisions on behalf of the child.

  2. Incomplete or unclear religious belief statement: The form mandates a clear statement that vaccinations conflict with your religious beliefs. Vague or incomplete explanations can lead to your affidavit being questioned or not accepted.

  3. Failing to notarize the document: The Georgia Vaccine Exemption form must be subscribed and sworn before a notary. Overlooking this step can render the document invalid, as it serves as official acknowledgment of your claim.

  4. Omitting required personal details: Every section of the form, including names and dates, must be filled out completely and legibly. Missing information can delay the exemption process or lead to denial.

Beyond these common mistakes, remember the importance of making an informed decision when it comes to vaccinations. Whether choosing to vaccinate or not, understanding the potential risks and benefits is key to ensuring the health and well-being of your child. When in doubt, consulting credible sources and healthcare professionals can provide valuable insight.

  • Take time to thoroughly research and understand both sides of the vaccine debate.

  • Consult with a healthcare provider who respects your beliefs and can offer informed advice.

  • Keep abreast of any changes in state laws or regulations regarding vaccine exemptions.

Finally, whether submitting the Georgia Vaccine Exemption form or navigating any other health-related legal process, attention to detail and adherence to procedures are paramount. Avoiding common mistakes can save time and ensure your rights and beliefs are respected.

Documents used along the form

When you're navigating the waters of vaccine exemptions, particularly in Georgia, the Ga Vaccine Exemption form is your anchoring document. However, this journey often requires additional paperwork to ensure your voyage is smooth and unimpeded. Below are documents that frequently accompany the exemption form, each playing a crucial role in the process.

  • Affidavit of Religious Belief: A formal statement where you declare, under oath, that your religious beliefs prevent you from vaccinating your child. This document solidifies the sincerity of your religious stance against immunization.
  • Medical Records: Comprehensive documentation of your child's medical history, including past vaccine reactions, allergies, or other health conditions, to support your exemption request.
  • Physician’s Letter: A letter from your child's doctor detailing any medical reasons why vaccinations could be harmful to your child's health. This could strengthen your case if you're seeking a medical exemption alongside a religious one.
  • Notarization Form: Since the vaccine exemption form and other affidavits may require notarization, having a standardized notarization form ready can expedite the process.
  • Proof of Legal Guardianship: If necessary, documents to prove you are the legal guardian or parent authorized to make medical decisions for the child in question.
  • Immunization Plan: For some, providing a plan for alternative disease prevention measures can be helpful. This document outlines how you intend to protect your child from vaccine-preventable diseases through other means.
  • Copy of State Immunization Laws: Having a copy on hand of Georgia’s immunization laws, specifically O.C.G.A. § 20-2-771, can provide clarity and support for your exemption claims during discussions with school or healthcare officials.

Navigating through the exemption process requires patience, a clear understanding of your rights, and a firm grasp of the necessary documentation. Armed with the right forms, you can ensure that your child’s health and educational journey aligns with your family's beliefs and preferences. Remember, every step taken is a step towards advocating for personal health freedoms and informed choices.

Similar forms

  • Religious Exemption Form for Other Vaccinations: Similar to the Georgia Vaccination Exemption form, religious exemption forms for vaccinations required by other states allow parents or guardians to opt-out of vaccines for their children based on religious beliefs. These forms typically require the parent or guardian to attest that vaccination conflicts with their religious beliefs, mirroring the affidavit requirement in the Georgia form.

  • Philosophical Exemption Form for School Immunization: Some states offer a philosophical or personal belief exemption for school immunizations, which, like the Georgia form, allows parents to bypass vaccination requirements not only on religious grounds but also for personal beliefs. These forms share the characteristic that the exemption is predicated on the parent or guardian's beliefs.

  • Medical Exemption Certificate for Immunization: While focusing on medical contraindications rather than religious beliefs, medical exemption certificates are similar to the Georgia Vaccine Exemption form in that they both allow certain children to be exempt from standard immunization requirements, with appropriate documentation from a healthcare provider or, in Georgia’s case, an affidavit from the parent or guardian.

  • Consent Form for Vaccine Administration: Conversely related, these forms are used for parents to consent to the vaccination of their child, highlighting the inverse relationship to an exemption form. Both forms are integral in the process of either consenting to or opting out of vaccines, emphasizing parental rights and decision-making based on informed choices.

  • Allergy Action Plan Form: Similar to an exemption form in the context of public health management within schools, this document outlines a child's allergies and how they should be managed. Like the vaccine exemption form, it requires detailed health information and instructions to ensure the child's well-being in case of exposure.

  • Notarized Affidavit Forms: These are documents where an individual swears before a notary that certain facts are true, similar to the affidavit part of the Georgia exemption form where a parent or guardian must swear that immunization conflicts with their religious beliefs. Notarized affidavit forms are used in various legal and personal matters, requiring solemn affirmation.

  • Emergency Contact Information Form: Schools commonly require these forms for each student, documenting contact information and parental instructions in case of emergency. Like the exemption form, it's a proactive measure designed to safeguard children’s health and well-being, albeit in a broader sense.

  • Declaration of Independence from Medication Administration in School: This document allows parents to declare that their child will not take medication or undergo certain medical interventions at school, which aligns with the spirit of autonomy and parental control evident in the vaccination exemption form.

  • Refusal of Recommended Vaccines Form: Some healthcare providers offer or require a form to be filled out by parents who refuse one or more recommended vaccines for their child, acknowledging the potential risks of non-vaccination. This form, like Georgia's, involves parents making informed decisions about their child's health interventions.

  • Child’s Health History Form for School Enrollment: Required by many schools, this form collects detailed health information about a student upon enrollment. It shares similarities with the vaccine exemption in that it provides the school with critical health information necessary to manage the child’s well-being in the educational setting.

Dos and Don'ts

When filling out the Georgia Vaccine Exemption form, there are several important dos and don'ts to keep in mind to ensure the process is completed correctly and efficiently. Below are key points to consider:

Things You Should Do:

  1. Ensure all information provided on the form is accurate and truthful, specifically your name and the name of your child, as false information can lead to rejection of the exemption form.
  2. Provide a clear and concise statement that articulates the religious beliefs that conflict with vaccination, as vagueness may result in unnecessary questions or delays.
  3. Have the vaccine exemption form notarized, as this is a legal requirement and adds credibility to the document.
  4. Keep a copy of the notarized exemption form for your records in case there are any future questions or disputes regarding your child’s vaccination status.
  5. Submit the exemption form to the appropriate official at your child’s school or the operator of the group program, in compliance with O.C.G.A. § 20-2-771 (4e).

Things You Shouldn't Do:

  • Do not delay filling out and submitting the vaccine exemption form, as this could interfere with your child’s school enrollment or participation in certain programs.
  • Do not provide misleading or false information about your religious beliefs to justify vaccination exemption, as this is unethical and can lead to legal consequences.
  • Do not forget to have the form notarized, since an unsigned or unnotarized form is often considered invalid.
  • Do not ignore the requirement to provide the exemption form to your child’s school administrator or the operator of the group program, as failing to do so may result in your child being excluded from attendance.
  • Do not overlook the importance of making an informed decision regarding vaccination, which includes understanding the potential risks and benefits associated with both vaccinating and not vaccinating your child.

Misconceptions

When it comes to the Georgia Vaccine Exemption form, there are several common misconceptions that can lead to confusion. Understanding the facts can help parents make informed decisions regarding their children’s health and education.

  • Misconception 1: The vaccine exemption is only available for children attending public schools.

    In fact, the exemption applies to all children enrolled in any school within Georgia, including private and public schools, as stated in the Official Code of Georgia Annotated § 20-2-771.

  • Misconception 2: Parents must present detailed religious reasons or documentation to qualify for an exemption.

    Georgia law requires only a signed affidavit from the parent or guardian stating that the immunization conflicts with their religious beliefs, without needing to provide further explanation or documentation of those beliefs.

  • Misconception 3: Once an exemption is granted, it cannot be revoked.

    While parents have the right to claim a religious exemption, the law specifies that immunizations may be required during epidemic stages, indicating that exemptions are not absolute in all circumstances.

  • Misconception 4: The exemption form prohibits any future vaccinations.

    The form does not permanently exempt a child from all vaccinations; parents can choose to vaccinate their children in the future if their beliefs or circumstances change.

  • Misconception 5: Submitting an exemption form exempts the child from all school health requirements.

    It is important to note that the exemption applies specifically to vaccinations. Other health requirements set by the school or state health authorities may still apply.

  • Misconception 6: The exemption form contains misleading or false information about vaccines.

    The statement concerning vaccines' risks and effectiveness, as well as alternative treatments and the benefits of non-vaccination, represents a viewpoint that parents should research and consider thoroughly. The form itself, however, is a legal document facilitating the right to a religious exemption in the state of Georgia.

Parents and guardians considering this exemption should carefully review all information, consult with healthcare professionals, and take into account the welfare of their child and community. Making an informed decision is crucial for the health and safety of all involved.

Key takeaways

Filing a Vaccine Exemption form in Georgia is a significant decision that necessitates understanding the legal, health, and educational implications for your child and the community. Below are key takeaways about completing and using the Georgia Vaccine Exemption form.

  1. The Georgia Vaccine Exemption form is intended for parents or guardians who object to immunizations on religious grounds as outlined in the Official Code of Georgia Annotated § 20-2-771 4.(e).

  2. To claim an exemption, the parent or guardian must furnish an affidavit swearing that the immunization conflicts with their religious beliefs.

  3. This exemption may not apply during an epidemic of a disease, where immunization could become a requirement for the child’s school attendance.

  4. The form requires the parent or guardian to certify that vaccination contradicts their religious beliefs, listing specific vaccines included under this exemption.

  5. Parents or guardians must provide a copy of the completed exemption form to their child’s school administrator or operator of the group program as mandated by Georgia statute.

  6. Decisions regarding vaccination should be made after informed consideration of the benefits and risks, including acknowledging the possibility of vaccine-related injuries or reactions.

  7. Choosing not to vaccinate may involve taking additional responsibilities to maintain the child’s health through alternative means, highlighting the importance of a strong immune system and good nutrition.

  8. Parents and guardians are encouraged to seek comprehensive information on vaccines and childhood diseases from a variety of sources to make a truly informed decision.

  9. If opting to vaccinate, any adverse reactions should be promptly reported to the Vaccine Adverse Event Reporting System (VAERS) to contribute to the collective understanding and safety monitoring of vaccines.

  10. In cases of vaccine injury, the child may qualify for compensation under the National Vaccine Injury Compensation Program, underscoring the need for keeping detailed records of the vaccination and any reactions.

It's crucial for parents and guardians to understand that this exemption is a declaration of deeply held religious beliefs against vaccination, and not a means to bypass school immunization requirements without valid cause. The well-being of the child, along with public health considerations, should always be at the forefront of such a decision.

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