Please find below a basic form that can be modified for your particular circumstance. This should be filed with schools, attorneys, doctors, hospitals, etc. as a counter to the No Blood Card.
Name of Minor:___________________________________________________
Name(s) of Legal Custodian:_________________________________________
I am a resident of the State of ____________, over the age of 18, and fully competent to make this statement.
I am a parent of the minor child, ___________________________. This minor is a resident of the state of _________.
It is my desire, in signing this document and making it available to you and your institution, to let it be know that I do not agree with and will not consent to the refusal of a blood transfusion or any similar, necessary medical treatment when it is deemed appropriate for the health of my child. The health and well-being of my child are of utmost importance to me and I respect the judgment of the medical community in this regard.
I am aware that this child may be in possession of a medical identity card distributed by Jehovah’s Witnesses. I am aware also, that the child’s mother/father may be one of Jehovah’s Witnesses and conscientiously object to medical treatment involving blood and/or blood products for medical use involving this child due to religious reasons. My child is not a baptized member of Jehovah’s Witnesses and cannot fully understand the implications of taking a stand regarding a life threatening situation based on Biblical reasoning endorsed by another person. My child is also a minor and not legally capable or bound to a medical decision made on his own behalf.
I am not one of Jehovah’s Witnesses and do not endorse this stand. As a parent to this child, I will be willing to sign waivers regarding the overriding of this document, if needed. I will also be willing to state this before a judge, if the matter is remanded to a court regarding the rights of my child.
I am attaching a copy of a recently published essay, "Jehovah's Witnesses, Blood Transfusions, and the Tort of Misrepresentation," in the Autumn issue of Baylor University’s Journal of Church and State, December 13, 2005. Information given to the Jehovah’s Witness parent has been proven to be a misrepresentation of the facts regarding blood and it’s use and I cannot agree with any decision not made without all the facts regarding a life-saving treatment.
I wish to be contacted in the event of a medical emergency involving this child. This may be objected to by the child’s mother/father but I am a legally recognized parent to this child and this is the lawful course. If you have any questions, please feel free to contact me.
I can be reached at:
I have filed a copy of this with my attorney and a copy has been given to the child’s mother/father.
I thank you, in advance, for your consideration in this matter.
DATED this ________ day of _________, 2006.
SUBSCRIBED AND SWORN to before me this _____ day of ___________, 2006.