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The Georgia Vaccine Exemption form provides an essential option for parents or guardians who wish to exempt their child from mandatory vaccinations based on religious beliefs. Under the Official Code of Georgia Annotated § 20-2-771 (4)(e), parents can formally object to vaccinations if they align with their spiritual convictions. To initiate this process, parents must complete an affidavit affirming their beliefs and submit it to the appropriate school or facility official. The form requires specific details, including the name of the child and the vaccines to be exempted, such as Diphtheria, Measles, and Polio, among others. Additionally, it is critical to understand that, in cases of an epidemic, certain vaccinations may still be mandated, regardless of the exemption. The document must be signed and notarized to confer legitimacy. Before making this important decision, individuals should consider the potential risks associated with both vaccination and non-vaccination, as well as the importance of informed consent. This includes recognizing the various reactions vaccines can provoke and which support measures may be necessary should adverse effects occur. The decision to seek an exemption is significant and should be approached with care and thorough research.

Ga Vaccine Exemption Example

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

Form Characteristics

Fact Description
Legal Basis The exemption form is based on the Official Code of Georgia Annotated § 20-2-771 (4e).
Affidavit Requirement Parents or guardians must submit an affidavit stating that vaccination conflicts with their religious beliefs.
Epidemic Clause Vaccinations may still be mandated during an epidemic, despite a religious exemption.
Signature Necessity The form must be signed by a parent or guardian and acknowledged before a notary public.
Information Resources Parents are encouraged to educate themselves on vaccines and potential risks before making their decision.

Guidelines on Utilizing Ga Vaccine Exemption

After obtaining the Vaccine Exemption form, there are specific steps to complete it correctly. Follow these steps to ensure the form is properly filled out before submitting it to your child’s school or relevant institution.

  1. Start by entering your full name in the blank space provided for the parent, guardian, or person in loco parentis.
  2. Next, fill in your child’s name where indicated.
  3. Indicate that the administration of any vaccine or immunizing agents is contrary to your religious beliefs by checking the appropriate option(s) for the vaccines listed. This includes Diphtheria, Measles, Tetanus, Mumps, Pertussis, Rubella, Polio, Haemophilus influenzae type b, Hepatitis B, Varicella, Smallpox, and Anthrax.
  4. Sign your name as the parent or guardian in the designated space.
  5. Enter the date of your signature.
  6. If applicable, repeat the signing and dating process for a second parent or guardian.
  7. Find a notary public who can witness your signing. Sign again in the presence of the notary.
  8. Have the notary complete their section, including their signature and seal, along with the date.

Once completed, this form should be submitted to your child’s school administrator or the operator of the group program. Ensure you keep a copy for your records.

What You Should Know About This Form

What is the purpose of the Ga Vaccine Exemption form?

The Ga Vaccine Exemption form allows parents or guardians to opt-out of immunizations for their children based on religious beliefs. By completing this form, you affirm that vaccinations conflict with your family’s religious principles. This document must be provided to school officials or operators of group programs to formally request the exemption.

What should I include in the affidavit?

Your affidavit must include your name as the parent or guardian, as well as your child's name. You will also need to state that the administration of any vaccine is contrary to your religious beliefs. You should specify which vaccines you refuse, such as Diphtheria, Measles, Tetanus, and others listed on the form.

Can my child be required to get vaccinated even if I submit this form?

What should I do if my child experiences a reaction to a vaccine?

Immediately contact your healthcare provider if you notice any changes in your child’s condition after vaccination. You should record any reactions and keep those notes for at least six months. If a serious reaction occurs, you can also report it to the Vaccine Adverse Event Reporting System for documentation and potential compensation.

Where can I find more information about vaccination risks and benefits?

Common mistakes

Completing the Georgia Vaccine Exemption form can present several challenges. One common mistake occurs when individuals fail to accurately fill in their names and the name of the child. This information must be complete to ensure that the exemption can be processed without delays. Omitting this crucial detail might result in the form being returned for correction.

Another frequent error is neglecting to specify the particular vaccines for which the exemption is being requested. The form includes a list of vaccines, such as Diphtheria, Measles, Tetanus, and others. Failing to check the boxes corresponding to these vaccines can create confusion and impede the exemption process.

Additionally, many individuals overlook the requirement for notarization. The form should be signed and notarized to be considered valid. If this step is skipped, the exemption may be rejected outright. It is essential to approach a notary with the completed form to ensure compliance with state requirements.

Another mistake is the improper completion of the signature section. Parents or guardians must ensure that they sign the document accurately and include the correct date. Inaccurate or incomplete signatures can lead to complications and delays.

Providing insufficient information about the child's medical history is another pitfall. The form requires that the parent or guardian briefly indicates any relevant health issues. Omitting this information can result in questions from the school administration and may affect the approval of the exemption.

Some individuals also neglect to provide a copy of the completed form to the relevant school administrator or facility operator. This step is crucial to inform the institution of the exemption. Not following through on this requirement can lead to misunderstandings or miscommunications.

Finally, a lack of research regarding the child's health status can lead to choosing not to fill out the exemption form accurately. Parents or guardians must fully understand their child's medical condition and any prior vaccine reactions. This knowledge is vital to making an informed decision about vaccination and filling out the exemption form appropriately.

Documents used along the form

When considering the Ga Vaccine Exemption form, various other documents may also be required to support a request for vaccination exemption or address related healthcare issues. Below is a list of common forms and explanations of their purpose.

  • School Enrollment Form: This document collects information on a student's personal details, emergency contacts, and medical history pertinent for school records, including vaccination status.
  • Affidavit of Religious Beliefs: This sworn statement provides more details about the specific religious beliefs that support the decision to refuse vaccinations.
  • Medical Waiver Form: If a child has a medical condition preventing vaccination, parents may complete this form, signed by a healthcare professional, to exempt their child for health reasons.
  • Health History Form: This form helps schools understand the general health of the child, including previous illnesses and any known allergies, aiding in suitable accommodations.
  • Immunization Record: While not directly related to exemptions, maintaining this document can be crucial for tracking vaccinations administered to the child, and for future schooling needs.
  • Letter from Healthcare Provider: A letter may be issued by a physician confirming that vaccination is not advisable for a particular child due to health concerns.
  • Emergency Contact Form: This document allows parents to provide contacts who can be reached in case of emergencies during school hours, ensuring timely communication.
  • Consent for Health Services Form: Schools may require this form to authorize various health services offered at school, potentially including immunizations, if the exemption is not in place.
  • Notification of Exemption Form: This serves to formally inform the school district about the intent to exempt the child from vaccination requirements.
  • Individualized Education Plan (IEP): In cases where a child has special educational needs, this plan outlines tailored support, which may include health-related accommodations.

Each of these documents plays an important role in ensuring that schools and parents are aligned on the health and educational needs of children, particularly when exemptions from vaccinations are being pursued. It is vital to understand which forms may be necessary, as this can ease communication with educational institutions and healthcare providers.

Similar forms

  • Personal Religious Exemption Letter: Like the Georgia Vaccine Exemption form, this letter allows parents to formally declare their objections to vaccinations based on personal religious beliefs. It requires a clear statement of the parent’s beliefs and is typically directed to a school or childcare facility.
  • Medical Exemption Form: This document is similar in that it allows parents to exempt their child from vaccinations. It specifically cites medical reasons, such as allergies or previous adverse reactions, which must be validated by a healthcare provider.
  • Philosophical Exemption Form: In some states, this form offers a broader exemption, permitting parents to refuse vaccines based on personal or philosophical beliefs. Like the Georgia form, it involves notifying an educational authority.
  • Religious Affidavit: This document functions similarly to the Georgia form by requiring a sworn statement that vaccination conflicts with religious beliefs. It’s often used in various legal contexts where religious freedom is asserted.
  • Notarized Exemption Letter: Similar to the GA Vaccine Exemption form, this letter must be notarized to fulfill legal requirements. It asserts that vaccinations are against the signatory's religious beliefs and provides legal backing to the request for exemption.
  • State Immunization Exemption Request: This request is filed with state health departments, analogously to the GA form, allowing parents to opt-out of immunization requirements based on specific criteria defined by state law.
  • Child Health Assessment Form: Although broader in scope, this document may also include sections for parents to discuss vaccinations and their views on medical interventions, making it comparable to the GA Vaccine Exemption if vaccination choices are mentioned.
  • Home Schooling Exemption Documentation: For families opting to home school their children, this documentation may include statements regarding immunization exemptions, similar to the formal declarations made in the GA form.
  • School Enrollment Health Form: This form often requires information about immunization status. Parents who decline vaccinations need to submit similar exemptions, making it related to the GA Vaccine Exemption process.
  • Informed Consent Form: An informed consent form is similar as it ensures that parents are making knowledgeable choices regarding their child’s vaccinations. It requires clear communication about the risks and benefits, echoing themes found in the GA Vaccine Exemption.

Dos and Don'ts

When filling out the Georgia Vaccine Exemption form, it's essential to approach the process with clarity and care. Here’s a helpful list of what to do and what to avoid.

  • Do thoroughly read the form and instructions before beginning.
  • Do provide accurate information about yourself and your child.
  • Do clearly state your religious beliefs that conflict with vaccination.
  • Do submit the form in a timely manner to the school or facility.
  • Don't leave any sections of the form blank unless instructed otherwise.
  • Don't use vague language when explaining your religious objections.
  • Don't forget to have the form notarized before submission.
  • Don't rely solely on verbal communication; always provide written documentation.

By following these guidelines, you can ensure that your application process is smooth and your intentions are clearly understood.

Misconceptions

Misconceptions about the Georgia Vaccine Exemption Form are common, and understanding these misconceptions is essential for parents and guardians. Below are ten prevalent misconceptions and their clarifications.

  • Misconception 1: The exemption is automatic.
  • Many believe that simply requesting an exemption guarantees it will be granted. In reality, parents must submit a formal affidavit affirming their religious beliefs against vaccinations.

  • Misconception 2: All schools accept the exemption without question.
  • Some parents think that all schools will accept their exemption requests. However, schools are obligated to verify that the exemption aligns with state laws and the specific requirements set forth in the exemption form.

  • Misconception 3: You cannot apply for an exemption during a disease outbreak.
  • While exemptions can be more complicated during outbreaks, they are not prohibited. Schools may require vaccinations during epidemics for safety, but families can still pursue exemptions on religious grounds.

  • Misconception 4: The exemption form is only for specific vaccines.
  • Some people think the form applies only to a few vaccines. However, it covers a broad range of vaccinations, including those against measles, rubella, and polio, among others.

  • Misconception 5: Submitting the form once is sufficient for all future school years.
  • Parents often believe a single submission suffices indefinitely. In fact, it may be necessary to renew the exemption every year or whenever new vaccines are introduced.

  • Misconception 6: You must follow specific religious doctrines to qualify for the exemption.
  • Some people think that only formal religious doctrines qualify for an exemption. However, personal religious beliefs, even if not affiliated with a structured religion, can be valid grounds for exemption.

  • Misconception 7: Healthcare providers can deny exemption requests.
  • It is a common belief that healthcare professionals have the authority to grant or deny exemption requests. In fact, it is up to the parents and the schools to handle exemptions based on the submitted affidavit.

  • Misconception 8: Immunizations are necessary for all children without exceptions.
  • Many assume all children must be vaccinated. Nevertheless, Georgia law provides stipulations allowing for exemptions based on specific criteria, including religious beliefs.

  • Misconception 9: There are no consequences for not vaccinating.
  • Some believe that not vaccinating poses no risks. In reality, unvaccinated children are at higher risk for contracting preventable diseases, and schools may have policies regarding non-vaccinated children.

  • Misconception 10: The process for exemption is too cumbersome to pursue.
  • Lastly, many parents think that the exemption process is overwhelmingly complicated. While there are steps involved, understanding the requirements and gathering necessary documentation can streamline the process considerably.

Understanding these misconceptions can empower individuals to make informed choices regarding vaccinations and exemptions in Georgia.

Key takeaways

1. Fill Out the Form Accurately: Ensure all required fields, such as your name and your child's name, are completed correctly. Inaccuracies may lead to delays or denial of the exemption.

2. Provide Affidavit for Religious Beliefs: Submit a sworn affidavit that clearly states your objection to vaccinations based on religious beliefs. This document is critical to substantiate your claim.

3. Notify the School or Facility: Deliver a copy of the exemption form to your child’s school administrator or the operator of the group program. Failing to do so may result in your child not being exempt from vaccination requirements.

4. Stay Informed on Vaccine Risks: Research the potential risks of vaccines thoroughly. Understand both the possible side effects and the nature of diseases your child may face without vaccination.

5. Reporting and Documentation: If your child experiences any adverse reactions after vaccination, report them to the Vaccine Adverse Event Reporting System. Keep detailed records of any reactions for potential follow-up or claims.