The wording of a back-to-school flu shot consent form sent home with students got under the skin of some central Texas parents, escalating to the point where an anti-vaccination group teamed up with a lawyer to issue a cease and desist letter.

On Facebook, Texans for Vaccine Choice posted they are “beyond tired of being on the defensive, so we have decided this year to take the bull by the horns and go on the offensive.” Attorney Briscoe Cain, the Republican challenger running for state House District 128, issued a seven-page cease and desist letter that asked school districts to stop their “Kick the Flu” campaigns, asserting they presented an “offensive” nature to the “principles that embody the parent-child relationship.”

The letter said the flu vaccine consent form attempted to “procure consent by guilt and shame.” Parents had two options to choose from on the form: “Yes, I want to help protect my family and my community from flu by allowing my child to receive a flu vaccine” and “No, I do not want to help protect my child and community by allowing my child to participate.” The “no” response sought a fill-in-the-blank explanation for opting out.

Amid parent outrage, the consent form was amended. “No” became “I do not wish to participate.” However, Cain’s letter said the revision did not go far enough to remedy the problem with a “suitable non-coercive substitute” such as simple yes and no boxes, without comments about helping the community.

Jackie Schlegel, the group’s director, said in a press release: “It was the coercive and unlawful approach taken by school districts and the blatant miscommunication used to seemingly pressure parents to have their children participate in the program. There is unlawful and blatant miscommunication that must cease today.”

The Austin American-Statesman reported filling out and returning the forms was optional, something they noted was unclear to some families who felt the wording made them appear as if they were not protecting their families or communities if declining the vaccine.

The letter posited other wrongdoings like state compliance issues with the consent form; the “Kick the Flu” program; and one of the vendors, Florida-based Healthy Schools, LLC. It raised questions about a child getting inoculated without a parent present as “an improper form of parent alienation.” Cain cited “discriminatory practices,” saying his clients believe children rewarded with a Health Hero wristband for getting a flu shot expose un-vaccinated children to “criticism and humiliation by their peers and school employees” including being singled out. These un-vaccinated children may even be angry with their parents because they did not get prizes.

Cain previously contacted five independent school districts for reportedly overstepping their authority in this matter–Austin, Bastrop, Fort Bend, Georgetown, and Leander. This letter went to nine more–Eanes, Del Valle, Elgin, Hutto, Lake Travis, Manor, New Braunfels, Pflugerville, and Round Rock. School districts partnered with Healthy Schools and E3 Alliance, an area education non-profit, for the flu shot drive.

“I could not care less if someone gets the flu shot. I get one each year. But the blatantly unethical actions by these school districts and the coercive nature of their actions should concern any Texas parent. There are clear discriminatory and illegal practices with the program’s procedures that must cease until they are fully corrected. I’m looking forward to working with the districts on resolving their misguided approach so the rights of children and parents are fully protected,” said Cain in the release.

Texas is one of 18 states that allows vaccination exemptions based on medical, religious, or personal beliefs. Breitbart Texas reported a nearly nine percent increase of Texas parents opting out of K-12 immunizations in 2015-16, compared to the year before. Still, the overall percentage of un-vaccinated school children remained minuscule. Only 0.84 percent of the estimate 5.5 million students enrolled in public, charter, and private schools are un-vaccinated. Regionally, Austin ISD reflected a higher rate of inoculation opt-outs–2.02 percent (or 1,582 students).

While parents may exercise their right to refuse vaccines, the Texas Department of State Health Services (DSHS) recently cautioned school administrators: “Immunizations are an important way to ensure the health and well-being of your students, their families, and your community.”

Texans for Vaccine Choice, a political action committee, formed in response to 2015 proposed state legislation by Rep. Jason Villalba (R-Dallas) that would have ended vaccination exemptions based on religious or other reasons of conscience in public schools and universities. Breitbart Texas reported the bill was one of a handful of proposed school immunization bills put forth during the 84th Legislature that did not pass.

Despite anti-vaxxer concerns, the U.S. Centers for Disease Control and Prevention (CDC) maintains the flu vaccine is safe. “Hundreds of millions of Americans have safely received flu vaccines over the past 50 years, and there has been extensive research supporting the safety of flu vaccines.” They recommend everyone six months of age and older get a flu shot annually.

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Briscoe Cain Letter to School Districts on Behalf of Texans for Vaccine Choice by BreitbartTexas on Scribd