| BlackCommunitycenter.com |
| BlackCommunitycenter.com |
| Martin Luther King conversing with the Messenger of the Nation of Islam Elijah Muhammad |
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| Return to the Top HPV Fact Sheet # 1 Volunteers Needed Here General Opt-Out Letter Letter of Support Contributions |
| Please copy |
| Use this Opt-Out Form for those attending Washington DC Public School system. Click Here and used this Form for other schools outside of Washington DC Public school system. |
| Please copy this HPV Opt-out Form and pass it on to your friends, family, and organizations |
| OPT-OUT REQUEST Date: School Name: _________________________________________ Address: _____________________________________________ _____________________________________________________ _____________________________________________________ To School Nurse, childcare Personnel: ______________________________ From: _____________________________________ (Print First, Last Name) My address is:_____________________________________ _________________________________________________ _________________________________________________ As you are probably aware, I receive a notice by the District of Columbia Public School (Name) _______________________________required to show documented proof of complete, correctly spaced immunizations or proof of medical or religious exemption to include new immunization requirements for School Year 2008-2009 and School Year 2009-2010. The D.C. Public School notices notes that by the first day of school for 2009 -201100 school year, documented proof of immunization for the following immunization will be required: Human Papillomavirus (HPV) entering grade 6 for first time and 11-12 years old. On the bottom of the letter in states that “Contact your healthcare provider to make an appointment for your child to receive the required vaccine(s). If you do not have health insurance or need a healthcare provider, please contact the Citywide Call Center at 3-1-1. If you have other questions or would like more information, please contact School /Childcare Personnel _____________________at phone # ( _) ________________ or email address:_________________________________. I am the ________________of ___________________ and I have substantial concerns about the safety and claim of experimental HPV vaccine being used, not least because of the promised of security against cervical cancer but because federal records revealed troubling data linking the current experimental HPV vaccines with deaths and disabilities in the very children it was suppose to help. I cannot in good conscious subject my daughter or any one else’s daughter, to the future risk and be denied her reproductive ability to conceive children. There are not any known HPV illnesses in children or any HPV emergency pandemic threatening the children health today or tomorrow. If there is, please prove it to me. My Daughter will not participate in the government HPV vaccine experimentation and will Opt-Out from further and future use as subject to this drug that has unnecessarily harmed so many of our youth. My only question is how can you as a nurse, administrator, and as a human being subject and push such a disabling drug onto female children in the Washington D.C. public school system. Please, acknowledge my request and your response in writing only. Sincerely,______________________________ |
