Overview
The Hawaii Vaccine Exemption form serves as a critical document for parents and guardians who choose to opt out of vaccinating their children based on personal beliefs or religious tenets. This form outlines the legal framework established by Hawaii law, specifically referencing sections of the Hawaii Revised Statutes and Hawaii Administrative Rules that allow for such exemptions. It emphasizes that while vaccinations are generally considered a public health measure, parents retain the right to refuse immunization for their children under certain circumstances. The form requires the parent or guardian to certify their decision not to vaccinate, citing concerns about potential health risks associated with vaccines, including severe injuries or even death. Additionally, it highlights the necessity of notifying the child’s school, ensuring that the institution is aware of the exemption status. Importantly, the document also warns that exemptions may not be recognized during outbreaks of communicable diseases, thereby underscoring the balance between individual rights and community health needs. As such, the Hawaii Vaccine Exemption form is not merely a procedural requirement; it represents a significant intersection of personal choice, public health policy, and legal obligations in the realm of childhood immunization.
Document Preview Example
attached: HRS
State of Hawaii Vaccine Exemption
Pursuant to:
Hawaii Administrative Rules
Hawaii Revised Statues
I understand that all children are susceptible to diseases, even if they are vaccinated for that particular disease. I understand that, according to the CDC vaccination does NOT provide immunity, and therefore my child could contract the disease, even if vaccinated.
Furthermore, I understand that there is significant risk involved with vaccination and that many children have become seriously injured, sometimes resulting in death, as a direct result of the vaccination. VAERS (Vaccine Adverse Event Reporting System) was specifically created by the government to handle the large number of people that have died or received serious injury from vaccination.
I understand that some advocates of vaccination (usually ones with a vested financial interest) report that vaccination can help prevent certain diseases. However, I do not believe the reported benefits outweigh the confirmed danger and risks inherit with vaccination.
If at any time there is, in the opinion of the Department of Health, danger of an outbreak or epidemic from any communicable disease for which vaccination is required, this exemption from vaccination shall not be recognized. As a result, my child will NOT be vaccinated, but will be excluded from school until the threat of an epidemic is over.
VACCINE REFUSAL FORM
I,____________________________, as the parent, guardian or person in loco parentis of
(insert your name)
the child _________________________, do hereby certify that the administration of any
(insert your child’s name)
vaccine or other “so called” immunizing agents is contrary to our bona fide religious
tenets and practices and our personal beliefs. In Summary, I directly forbid any and all
parties, public or private, to administer any form of vaccination to my child.
This is pursuant to my right to refuse vaccination based on Hawaii State Law (see
Pupil’s Name:_________________________________ |
Date of Birth:______________ |
School:______________________________________ |
Grade:____________________ |
Parent/Guardian Name (print) :_____________________________________________________
Parent/Guardian Signature:________________________________________________________
Date:_________________________
(1)If a licensed physician certifies that the physical condition of the child is such that immunizations would endanger the child's life or health; or
(2)If any parent, custodian, guardian, or any other person in loco parentis to a child objects to immunization in writing on the grounds that the immunization conflicts with that person's bona fide religious tenets and practices. Upon showing the appropriate school official satisfactory evidence of the exemption, no certificate or other evidence of immunization shall be required for entry into school. [L 1996, c 89, pt of §2]
If at any time there is, in the opinion of the department of health, danger of an epidemic from any of the communicable diseases for which immunization is required under sections
Section
No person shall be subjected to vaccination, revaccination or immunization, who shall in writing object thereto on the grounds that the requirements are not in accordance with the religious tenets of an established church of which the person is a member or adherent, or, if the person is a minor or under guardianship, whose parent or guardian shall in writing object thereto on such grounds, but no objection shall be recognized when, in the opinion of the director of health, there is danger of an epidemic from any communicable disease.
(a)Medical exemptions from the requirements for specific immunizing agents shall be granted upon certification by a physician on the physician’s professional stationery that an immunization is medically contraindicated for a specific period of time. The original certificate shall be provided to the exempt person or parent or guardian. A copy of the certificate shall be maintained in the student’s school health record. Reports of such certificates shall be submitted to the department by each school.
(b)A religious exemption shall be granted to a student whose parent, custodian, guardian, or other person in loco parentis certifies that the person’s religious beliefs prohibit the practice of immunization. Requests for religious exemptions based on objections to specific immunizing agents will not be granted. Students who have reached the age of majority shall apply on their own behalf. The certification shall be retained in the student’s health record. Reports of such exemptions shall be submitted to the department by each school.
(c)If at any time, the director determines that there is the danger or presence of an outbreak or epidemic from any of the communicable diseases for which immunization is required under this chapter, the exemption from immunization against such disease shall not be recognized and inadequately immunized students shall be excluded from school until the director has determined that the presence or danger of the outbreak or epidemic no longer exists.
Making Informed Decisions
Your decision to vaccinate or not should be an informed decision. Vaccines can cause severe injuries such as seizures, death, anaphylaxis, brain damage and other reactions. The type and severity of reactions may vary from vaccine to vaccine and child to child. The effects of a vaccine injury may be temporary or permanent. If you notice any changes in your child’s condition after receiving a vaccine, you should contact your doctor immediately or go to a hospital. Vaccines have never been proven to be safe or effective and your child may contract the disease even if he is vaccinated. What has been proven is that you can get the disease from the vaccine or from coming into contact with a recently vaccinated person. The polio vaccine is just one example. It is a known fact that most healthcare providers do not fully inform patients of the side effects a vaccine can have on the body, brain and immune system. Because of the highly toxic ingredients all vaccines contain, you should thoroughly research vaccines for yourself before making such an important decision. DO NOT allow someone else, even your healthcare provider, scare or force you into making this decision without being fully informed. Many healthcare providers have not researched vaccine history or toxicology and are not fully informed. Always provide a detailed history of your child’s health to your doctor. Make sure they know of allergies, neurological problems, nutritional deficiencies, any immune system disorder and skin diseases such as eczema. Most physicians and nurses do not warn parents that if their child’s health is compromised in any way, such as having a common cold or previous reaction to a vaccine, they should not receive vaccines.
Benefits of
When you choose to not vaccinate your child, you have the responsibility to educate yourself on how to maintain the
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)
National Vaccine Information Center – www.909shot.com or (800)
(NOTE: The two websites above, Vaccination Liberation and the National Vaccine Information Center, have proven to be excellent sources for extensive vaccine information.)
Reporting Reactions
If you do decide to vaccinate, report vaccine reactions to:
Vaccine Adverse Event Reporting System (800)
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.
Revised 11/2008 Source: |
A New Life Family Chiropractic |
|
803 Kamehameha Hwy., Suite 301 |
|
Pearl City, HI 96782 |
This form may be reproduced
How to Fill Out Hawaii Vaccine Exemption
Completing the Hawaii Vaccine Exemption form is a straightforward process. Once you have gathered the necessary information, follow the steps outlined below to ensure that your form is filled out correctly and submitted properly.
- Begin by writing your name as the parent, guardian, or person in loco parentis in the designated space.
- In the next section, insert your child's name where indicated.
- Fill in your child's date of birth in the appropriate field.
- Provide the name of the school your child attends.
- Indicate your child's grade level in the school.
- Print your name as the parent or guardian in the specified area.
- Sign the form in the space provided to confirm your request for exemption.
- Date the form to indicate when it was completed.
- Make a copy of the completed form for your records.
- Submit the original form to your child's school administrator or the operator of the child's group program.
After submitting the form, the school will review it to ensure that all necessary information is included. They will then keep it on file as part of your child's health records. It is important to stay informed about any updates regarding vaccination requirements or potential outbreaks that may affect your child's exemption status.
Common mistakes
Filling out the Hawaii Vaccine Exemption form requires careful attention to detail. One common mistake is failing to provide accurate personal information. Parents must ensure that the child's name, date of birth, and school details are filled in correctly. Any discrepancies can lead to delays or complications in processing the exemption.
Another frequent error involves incomplete signatures. It is essential that the parent or guardian signs the form where indicated. Omitting a signature can render the form invalid, which may result in the child being required to receive vaccinations.
Some individuals neglect to include the specific grounds for the exemption. The form allows for exemptions based on religious beliefs or medical conditions. Clearly stating the reason for the exemption is crucial for the form's acceptance.
Additionally, people often overlook the requirement to submit the form to the appropriate school official. After completing the exemption form, it is the parent's responsibility to ensure that it reaches the designated authority. Failing to do so may mean the exemption is not recognized.
Another mistake is not keeping a copy of the submitted form. Parents should always retain a copy for their records. This can be useful for future reference or if any questions arise regarding the exemption.
Misunderstanding the exemption criteria can also lead to errors. Parents should familiarize themselves with the specific laws and regulations governing vaccine exemptions in Hawaii. This understanding helps in accurately completing the form and ensuring compliance.
Some individuals may rush through the form, leading to typographical errors. Taking the time to review the completed form before submission can help catch any mistakes that could cause issues later.
Moreover, failing to check for updates to the exemption process can be a mistake. Regulations may change, and it is important to stay informed about any new requirements or procedures that may affect the exemption.
Lastly, parents sometimes do not seek assistance when needed. If there are uncertainties about how to fill out the form, reaching out to school administrators or health officials can provide clarity and guidance. Seeking help can prevent avoidable mistakes and ensure that the exemption is processed smoothly.
Documents used along the form
The Hawaii Vaccine Exemption form is an important document for parents who wish to exempt their children from vaccinations based on personal beliefs or religious tenets. Along with this form, there are several other documents that may be necessary or helpful in the process of securing an exemption. Here are five commonly used forms and documents:
- Medical Exemption Certificate: This document is provided by a licensed physician. It certifies that a child's medical condition makes vaccinations dangerous for them. This certificate must be kept on file at the child's school.
- Religious Exemption Statement: A written statement from a parent or guardian asserting that vaccinations conflict with their religious beliefs. This document supports the claim for a religious exemption and should be submitted to the school.
- School Immunization Records: These records show a child's vaccination history. Schools may require these documents to verify which vaccinations the child has received, if any.
- Health History Form: This form provides a detailed account of a child's health background. It can help healthcare providers understand any specific health concerns that might affect vaccination decisions.
- Motorcycle Bill of Sale Form: For those engaging in motorcycle transactions, the essential Motorcycle Bill of Sale documentation is vital to formalize the sale.
- Vaccine Adverse Event Reporting System (VAERS) Report: If a child experiences an adverse reaction to a vaccine, this report can be filed to document the incident. It is essential for tracking vaccine safety and can be used in discussions about vaccination risks.
Understanding these documents can help parents navigate the exemption process more effectively. Each plays a role in ensuring that parents can make informed decisions regarding their child's health and educational needs.
Other PDF Forms
Hawaii N-15 - The form includes a declaration confirming the accuracy and completeness of the information provided.
The importance of having a well-documented transaction when dealing with recreational vehicles cannot be overstated, and for this purpose, the Texas Documents provide a reliable RV Bill of Sale form that ensures both parties are protected in their agreement.
Hawaii T1 - Applicants can declare if they are the originator or assignee of the trade name.
Obtain Answers on Hawaii Vaccine Exemption
What is the Hawaii Vaccine Exemption form?
The Hawaii Vaccine Exemption form is a document that allows parents or guardians to request an exemption from required vaccinations for their child. This exemption can be based on personal beliefs or religious tenets. The form must be submitted to the child's school or group program administrator, along with any necessary supporting documentation as required by Hawaii state law.
Who is eligible to use the Hawaii Vaccine Exemption form?
Any parent, guardian, or person in loco parentis can utilize the Hawaii Vaccine Exemption form for their child. The exemption can be granted on the basis of a bona fide religious belief or personal belief that conflicts with immunization requirements. Additionally, medical exemptions may be available if a licensed physician certifies that vaccination would endanger the child's health.
What are the steps to complete the Hawaii Vaccine Exemption form?
- Obtain the form from the appropriate source, such as the school or health department.
- Fill out the required information, including the child's name, date of birth, school, and grade.
- Clearly state the reason for the exemption, citing religious or personal beliefs.
- Sign and date the form to certify the information provided.
- Submit the completed form to the child's school administrator or group program operator.
What happens if there is an outbreak of a communicable disease?
If the Department of Health determines that there is a danger of an outbreak of a communicable disease for which vaccination is required, the exemption will not be recognized. In such cases, the child may be excluded from school until the threat of the outbreak has passed. This is to ensure the safety and health of all students.
Can I request a religious exemption for specific vaccines?
No, requests for religious exemptions based on objections to specific immunizing agents will not be granted. The exemption must be based on a general objection to vaccinations as a whole, not on individual vaccines. The certification must reflect the overarching religious beliefs that prohibit immunization.
What should I do if my child has a reaction to a vaccine?
If your child experiences any adverse reactions following vaccination, it is important to report these reactions to the Vaccine Adverse Event Reporting System (VAERS). Keeping a detailed record of the vaccine name, manufacturer, lot number, and any reactions observed is crucial. This information can be helpful for monitoring long-term effects and may also assist in seeking compensation if necessary.
Where can I find more information about vaccines and exemptions?
For further information regarding vaccines, their risks, and the exemption process, several resources are available. The U.S. Centers for Disease Control and Prevention (CDC), public health libraries, and state health agencies provide valuable information. Additionally, organizations such as the National Vaccine Information Center and Vaccination Liberation offer extensive resources on vaccine safety and informed decision-making.
Document Attributes
| Fact Name | Description |
|---|---|
| Governing Laws | The Hawaii Vaccine Exemption Form is governed by Hawaii Revised Statutes §302A-1156, §302A-1157, and §325-0034, along with Hawaii Administrative Rules §11-157-5. |
| Purpose of the Form | This form allows parents or guardians to formally refuse vaccinations for their child based on religious beliefs or personal convictions. |
| Health Risks | The form acknowledges that vaccinations carry risks, including severe injuries and, in rare cases, death. |
| Understanding Immunity | It is noted that vaccines do not guarantee immunity, and vaccinated children can still contract diseases. |
| Exclusion from School | Children who are not vaccinated may be excluded from school during outbreaks of communicable diseases. |
| Religious Exemption | A religious exemption can be claimed if vaccination conflicts with the bona fide religious tenets and practices of the parent or guardian. |
| Certification Requirement | The form must be certified by the parent or guardian, stating their refusal of vaccination for their child. |
| Medical Exemptions | Medical exemptions are available if a licensed physician certifies that vaccination would endanger the child's health. |
| Reporting Adverse Events | Parents are encouraged to report any adverse reactions to vaccines through the Vaccine Adverse Event Reporting System (VAERS). |
| Educational Responsibility | Parents who choose not to vaccinate are urged to educate themselves on childhood diseases and their management. |
Misconceptions
Understanding the Hawaii Vaccine Exemption form can be challenging, and there are several misconceptions that often arise. Below is a list of six common misunderstandings, along with explanations to clarify each one.
- Misconception 1: The form allows anyone to opt out of vaccinations without consequences.
- Misconception 2: All children who submit the exemption form will automatically be allowed to attend school.
- Misconception 3: Parents can claim a vaccine exemption for any reason.
- Misconception 4: The Vaccine Adverse Event Reporting System (VAERS) proves vaccines are unsafe.
- Misconception 5: Vaccination is completely voluntary in Hawaii.
- Misconception 6: Submitting the exemption form means that parents do not need to educate themselves about vaccinations.
This is not true. While the form does provide a means for parents to refuse vaccinations on religious or personal belief grounds, it also states that if there is a danger of an outbreak, the exemption may not be recognized. In such cases, unvaccinated children may be excluded from school until the threat has passed.
This is misleading. The exemption is contingent upon the approval of school officials, and it is important to provide satisfactory evidence of the exemption. If an outbreak occurs, the school may enforce vaccination requirements despite the exemption.
This is incorrect. The law specifies that exemptions can be granted based on bona fide religious beliefs or if a licensed physician certifies that vaccination would endanger the child's health. Other reasons may not be accepted.
While VAERS does collect reports of adverse events following vaccination, it does not establish causation. Reports can include any health issue occurring after vaccination, regardless of whether the vaccine caused it. This system is meant to monitor safety, not to declare vaccines unsafe.
Vaccination is not entirely voluntary, especially in the context of public health. The law allows for exemptions, but during public health emergencies, the state can require vaccinations to protect the community, which may limit the ability to refuse.
This is a dangerous assumption. Parents who choose to exempt their children from vaccinations should still educate themselves about the potential risks of both vaccination and the diseases they prevent. Understanding these factors is crucial for making informed decisions about their child's health.
Key takeaways
When filling out and using the Hawaii Vaccine Exemption form, consider the following key takeaways:
- Understand Your Rights: The form allows parents or guardians to refuse vaccinations based on their religious beliefs or personal convictions, as recognized by Hawaii state law.
- Complete the Form Accurately: Ensure that all required fields, such as your child's name, date of birth, and your signature, are filled out correctly to avoid delays or issues.
- Submit to the School: After completing the form, provide a copy to your child's school administrator. This step is crucial for ensuring that your child's exemption is recognized.
- Stay Informed: Be aware that exemptions may not be recognized during an outbreak of a communicable disease. Stay updated on public health guidelines that may affect your child's school attendance.