AFFIDAVIT

DECLARATION OF VACCINATION EXEMPTION

Pursuant to The Constitution of Barbados Section 11 under the title Fundamental Rights and Freedoms of the Individual;
Section 19 under the title Protection of freedom of Conscience and The United Nations Committee on Economic, Social
and Cultural Rights 2000. (Right to be free from non-consensual treatment)

I hereby declare that I, having responsibility for myself, named __________________________________who is an adult,
withhold my consent and let it be known that I am exempt from any and all immunizations and/or vaccinations on the
grounds that such is contrary to my personal and/or religious beliefs.

CONSTITUTION OF BARBADOS SECTION 11(a) & (d) AND SECTION 19(1) & (5)

The United Nations Committee on Economic, Social and Cultural Rights 2000 Comment No 14 (Art. 12)

11. Whereas every person in Barbados is entitled to the Fundamental rights and freedoms of the individual, that is to say,
the right, whatever his race, place of origin, political opinions, colour, creed or sex, but subject to respect for the
individual rights and freedoms of others and for the public interest, to each and all of the following, namely- (a) life,
liberty and security of the person;

(d) freedom of conscience, of expression and of assembly and association.

19. (1) Except with his own consent, no person shall be hindered in the enjoyment of his freedom of conscience and for
the purpose of this section the said freedom includes freedom of thought and of religion, freedom to change his religion or
belief, and freedom, either alone or in community with others, and both in public and in private, to manifest and propagate
his religion or belief in worship, teaching, practice and observance.

(5) No person shall be compelled to take any oath which is contrary to his religion or belief or to take any oath in a
manner which is contrary to his religion or belief.

Any person, or medical authority which tries to enforce immunization or vaccination on my person is in violation of the
laws of Barbados and may be subject to prosecution.

Constitution of Barbados; Chapter 1. This Constitution is the supreme law of Barbados and, subject to the
provisions of this Constitution, if any other law is inconsistent with this Constitution, this Constitution shall prevail
and the other law shall, to the extent of the inconsistency, be void.

SUSCRIBED AND AFFIRMED BY ME ON THIS DAY OF 2021

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Signature and date

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Notary Public