Statement Of Objections To Health printable pdf download

Statement Of Objections To Health

Statement of Objection to Health

Examination and Immunizations

School Name:

_______________________________________________________________________

Address:

_______________________________________________________________________

Student:

_______________________________________________________________________

Address:

_______________________________________________________________________

We, Legal Parents/Guardians

___________________________________________________________

state that the above child is hereby exempt from immunizations against Diphtheria, Pertussis,

Tetanus, Poliomyelitis, Measles, Rubella, Mumps, Haemophilus Influenzae, Varicella, and

Hepatitis B on RELIGIOUS GROUNDS of the ILLINOIS SCHOOL CODE, 105 ILCS 5/278.1,

since it is in conflict with my bona fide and sincerely held religious beliefs and practices

regarding natural health. Compulsory immunizations violate the God created laws of health by

introducing unnecessary toxins which destroy the builtin mechanism for developing immunity

that is present in a healthy body put forth within us by a higher force at creation.

We, Legal Parents/Guardians of the above stated assume FULL RESPONSIBILITY of this

child's health, thus removing same from school as far as compulsory immunizations go.

________________________________________________

(Parent's Name) Date

________________________________________________

(Parent's Name) Date

This form is to be attached to my child's health record.

Statement Of Objections To Health