Vaccine Religious Exemption Form & Ivermectin info

Note this form was updated on 10/22/21

Numerous folks have used this form or their own and told us they were granted the exemption.

Has your employer or school or college mandated that you or your kids have the vaccine or risk being fired or discharged or refused admission? You should file a religious exemption form before they fire you.

PLEASE READ THIS COMPLETELY – This is information that we have understood and are passing on from our discussions with Lawyers. Your case maybe different – if so contact the lawyers directly (see below).

Note if you are a government employee who may lose your benefits if you are terminated, you will have to weigh your options. See section 2 below.

Section 1
  • If you do NOT have such a termination clause that would cause you to lose benefits etc., then do NOT resign from your post if you can. Submit the form (see below) and see what they say.  If they threaten to fire you, do NOT resign. If you want to litigate, you must wait till they fire you. But until then, you should be a model employee and do your duties as a workman approved unto God, refusing only to do that which would be a moral compromise of your conscience. In case of a litigation the judge must also feel that you have done your best to comply and do your job within your Biblical moral bounds.
  • If you do get a waiver you may need to prove you are not sick on a regular basis (Yes I know it makes no sense since vaccinated people can also catch COVID). If you are worried about the nasal swab, then you can ask them for a saliva test (they really need to pay for it but may not).
  • If your employer accepts the form but puts you on unpaid leave, there are lawyers who will take up your case. Especially, if you an employee at a large company like United or Google etc. It will be free for you.
  • You do not need to be part of our ministry or a church to use our form. You just have to sincerely believe and agree with what is written there. If you want to support our ministry you may do so here and we welcome you to Relentless Church if you live in San Jose.  Relentless Church meets at 4pm on Sundays at the Treasury Room (on the Calvary Chapel Campus at 1175 Hillsdale Ave, San Jose, CA 95125).
  • Calvary Chapel SJ has been open almost the entire time in defiance of the County’s Mandates and have over $3.6M in fines (that I assure you, we won’t be paying. This is going all the way to the Supreme Court and the County will pay for ALL the lawyers’ fees).

    We have also given rise to a Recall Movement to recall the Santa Clara County Board of Supervisors for their violation of our rights and for wasting County money on lawyers who have no chance of winning. If you are upset that you have to submit a Vaccine Exemption form, you should join the recall. (provided as a service to the Recall Santa Clara Committee).

    The form is below Section 2

  • Section 2
  • If you are a government employee who may lose your benefits if you are terminated
    I have been told that you may not automatically lose your benefits for termination, you still get to keep anything you’ve vested so far. But this is something you will need to clarify with a labor attorney or your union. If you will lose your benefits, you will have to weigh your options. The best thing is to have a very friendly discussion with your HR and Supervisor. Ask: I’m curious, I have a hypothetical question, let’s say someone does not want to take the vaccine, will you accept a Religious Exemption form or will you terminate them. Note I would advise you not to discuss that you are NOT going to take the vaccine till you know. You want to know what they are going to do. You will have to judge their reaction. They may lie, so if it seems likely that they will terminate you, you may be then need to retire/resign with your benefits intact. I would not advertise or argue with your colleagues about your position on the vaccination until you have determined this.
  • If your employer or other employees discriminate against you in anyway, please contact AFF  at or PJI at
You have 2 options with submitting a form:

Option 1. Fill out the form above with just your name and date give it to your HR or the Admissions Office (for a school). Note there are two pages. You may not need to give them the second page, you can decide on your own. It’s only if they ask for evidence or want to ask more questions, but we recommend hitting them with all 4 barrels. So include both documents above.

  • BUT please first read the forms carefully so you understand what you are objecting to. You do not need to be an expert on each of the items, only that a pastor has advised you to follow it and these are your sincerely held beliefs. Make sure they are indeed your sincerely held beliefs. You may use Neil Mammen as your pastor if you agree to the points being made. We also suggest you come visit Relentless Church for services. Relentless Church meets at 4pm on Sundays at the Treasury Room (on the Calvary Chapel Campus at 1175 Hillsdale Ave, San Jose, CA 95125). Pastor Jeff is the senior pastor and he can physically sign the forms for you after service.
  • If you are not a Christ Follower and would like to accept Jesus as your Lord and Savior, please email me.
  • You will need to be solidly pro-life to use this form. If you need to find out more about the pro-life position please go here:

Option 2. Write your Exemption form in your own words  (preferred so you can learn more). See below for details on this.

If you are with the county. Use their form.

Let’s look at the county form for a bit:
You’ll notice there are 3 questions.
What we recommend is that you write: “Please see attached.
Then on a full sheet of paper you fill out in hand, your objections.
What do you write? Study the text on our form for ideas and examples
  1. Pray about your convictions.
  2. Say you wish to be exempted from all vaccine mandates due to your religious convictions.
  3. Have a discussion about the Biblical reasons of why one would object to the vaccine with fellow Christians. Take out your Bible and do a study on these issues. Go online and look up Biblical Reasons against aborted baby fetal cells.
  4. Invite friends who are in the same situation to do a Bible Study with you to look into these issues
  5. On my website, I talk about what abortion is and why it’s evil. Aborted baby fetal cells are used for some vaccines
  6. Remember you are probably not an expert on the science, so do NOT argue about the scientific facts. You do not need to prove that there are people who have died as a direct result of the vaccine. Just that they have died after taking the vaccine and that you are genuinely concerned that you could die too, or not be able to have kids or have severe health issues and why this violates your sincerely held Biblical values.
  7. When you write it out, make sure you cover multiple reasons like our form does, so that if some vaccines do not use aborted fetal cells, then you still have other reasons to reject those vaccines.
You have to be proactive and educated. Maybe God is doing this so you actually read his Word and see how it applies to the world. Read your Bible daily.
3. Wait until you hear back and if it is rejected. Then contact AFF and PJI. They are lawyers who will take on cases for free.
Here’s how you contact them click on the links below.
Do not be confused or demoralized. Remember, we win in the end.

This is a propaganda war. So you need to surround yourself with like-minded people. They are trying to make you think there are only a few of us, that you are all alone, that you are the exception to the rule. That’s a lie. Remember YOU ARE NOT ALONE. The best place to meet like minded people is at a Church that is not buying into the mania.

You need to be in a weekly bible study with like-minded people.
Join the Calvary Book club, one book that they are going to be doing soon is Live not by Lies. You will be inspired and emboldened by it.
If you want to find out who would most likely be your supporters at work, start a Biblestudy at your work place.
I am a scientist but not a doctor, so here is what I have found, there are over 63 Studies that show that Ivermectin works and is effective in most cases. Yes you can get Ivermectin it from other sources, but make sure your dosage is right or it can hurt you. You should be taking it as a preventative medicine anytime you think you may have been exposed. And it seems that you should take it if you start feeling sick to stop the progress of the disease. But that’s a decision best made by a doctor. Note there are some hospitals in the Fresno area that are prescribing Ivermectin. It’s important to have some on hand.
Meta analysis using the most serious outcome reported shows 72% [55‑82%] and 86% [75‑92%] improvement for early treatment and prophylaxis (i.e. as a preventative drug), with similar results after exclusion based sensitivity analysis and restriction to peer-reviewed studies or Randomized Controlled Trials.
Statistically significant improvements are seen for mortalityhospitalizationrecoverycases, and viral clearance. 27 studies show statistically significant improvements in isolation. The probability that an ineffective treatment generated results as positive as the 63 studies is estimated to be 1 in 1 trillion.
Here are some of the over 63 studies showing that Ivermectin, a drug that has been given over a billion times and whose creator won the Nobel Peace Prize in 2015 is effective for COVID and yet there has been a ban on its use. The fact that there has been a concerted effort to impose vaccines on every human and a purposeful attack and suppression of news of alternative treatments has led me to be suspicious of the true intentions of the policymakers and to suspect that behind all this is greed, avarice, and lust for power. All traits of evil rulers in the Bible and Bible prophecy.
    1. An analysis of 63 studies, 44 were peer reviewed studies for COVID treatment.
    2. Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19
    3. Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines
    4. Effects of Ivermectin in Patients With COVID-19: A Multicenter, Double-Blind, Randomized, Controlled Clinical Trial
    5. Links to additional studies can be found here:


There is a movement to recall the Santa Clara County Supervisors who have fined churches and businesses over $6M- The recall group can use volunteers, sign up here. You can help even if you don’t live in the County but wish to send a message to local tyrants.
See their website here:

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