Vaccinations have been proven to be extremely hazardous, unsafe, contaminated and often completely ineffective. They have even been used to fraudulently deliver sterility drugs under guise of "Malaria" vaccines!
Tens of thousands of people are killed every year by vaccines, millions are injured permanently worldwide. Correlation to autism is now scientifically confirmed, yet the same vaccine regimens are still prescribed!
Even after decades of tragedies and atrocities caused by vaccinations, pharmaceutical interests have been allowed to buy corrupt legislation to try and force literally every American to accept this invasive and dangerous treatment.
Vaccines have been scientifically proven to have caused a worldwide Autism epidemic, Gardasil has been found to cause disability and death, and many other vaccines are known to cause host of crippling and life-threatening injuries, illnesses and unexpected consequences.
Pharmaceutical companies have even obtained legislation making themselves IMMUNE FROM LIABILITY for the harm they know vaccines cause! People only seek immunity when they KNOW THEY ARE GUILTY.
If you are being pressured to accept a vaccine for yourself or your children, DO NOT do so until you REQUIRE THE VACCINE PROVIDERS AND REGULATION ENFORCERS ACCEPT LIABILITY FOR THE DAMAGE THEY CAUSE with the free download contract form above titled "Vaccination Notice".
THIS IS NOT A FORM YOU SIGN. This is a form you present to your healthcare providers and REQUIRE THEM TO SIGN to insure the safety of their vaccinations, or at least accept personal responsibility to pay for any damages caused by their vaccinations.
Before accepting vaccinations for you or your child it is critical to get the providers of those vaccines to sign this form accepting liability and admitting the hazards so that you will have recourse against the many serious injuries and illnesses which vaccines are known to cause.
Of course, the healthcare providers may resist taking responsibility for what they are doing, but if they refuse to sign this form, you have legal grounds to refuse the vaccination.
You are welcome to modify the form or have an attorney do so, it is a free template.
Vaccine providers and regulators may refuse to sign this form because they know they are peddling poison, but refusal to sign the form is ADMISSION that harm may result from the vaccination. If vaccinations were truly harmless, they would gladly sign the form and accept liability.
If the vaccination providers do not sign the form, and thereby infer that vaccinations are hazardous, they have no right to demand that you accept their dangerous and ineffective medical treatments.
By the way, if you disagree with any of the above points and you believe people may be forced to accept risky medical treatments such as vaccines, then contact us. You may be invited to participate in a videotaped and published debate opposite medical researchers and scientists on the health effects and safety record of vaccines. Can you support the idea of mass forced vaccinations by non-physician politicians? Here's your chance!
- CONDITIONAL ACCEPTANCE OF VACCINATION -
- AGREEMENT BETWEEN VACCINE PROVIDERS AND
VACCINATED PARTY -
Herein the terms “administration” and
“administrators” refers to all parties providing and/or “mandating” vaccine
services and products including vaccine Manufacturers, Marketers, Lobbyists,
Distributors, Hospitals, Clinics, Physicians, Nurses, Government Agents and
Agencies, Healthcare Providers, Elected Officials, Enforcement Persons,
Agencies and Programs, and all other parties bringing “mandated” vaccines to
application or to market in any way.
This is agreement between the parties
identified herein who on one hand, will receive vaccinations or be affected by
the consequences of vaccination including the vaccinated party/s their
guardians, representatives and all persons of common interests and, on the
other hand, the administrators and providers of the vaccine/s in all the
various capacities. Those parties shall be identified at the end of this
document.
Individual intended for Vaccination:____________________________________
Circle one: Adult Minor
Parents' or Guardian's Names and/or Head of
Household: ____________________________________
Children's names (all family
members):____________________________________
__________________________________________________________________________________
Address:____________________________________
Phone:____________________________________
Other contacts if
available:____________________________________
Name of vaccine to be
provided_______________________________________________
As administrator of this vaccine I
hereby agree to and with the following representations, stipulations, terms, declarations and
positions:
1.
I am aware and understand that
vaccines are not a perfect or fully proven method of disease control.
2.
I am aware and understand that
vaccines are not 100% effective.
3.
I am aware that vaccines have
not been tested enough to show that they are 100% safe and effective.
4.
I am aware and understand that
vaccines can cause death or injury and disease which seriously and negatively
affects the lives of vaccinated individuals, their families and their
communities.
5.
I am aware and understand that
vaccines, when causing disease and injury, can cause major costs to
individuals, families and communities, which costs are solely the
responsibility and liability of the causing agents which are the administrators
and providers of a harming or ineffective vaccine.
6.
I am aware and understand that
vaccines cause risk which is the sole responsibility of the administrators and
providers of the vaccine.
7.
I am aware and understand that
no one may be forced, coerced or compelled to accept medical treatment or
foreign substances inserted into their bodies without full voluntary consent
under full disclosure and that administering a treatment, harmful or otherwise,
without consent of all affected parties is unlawful and unethical.
8.
I am aware and understand that
vaccinations do, on occasion, cause harm, injury and disease including the
disease they are intended to prevent.
9.
I am aware and understand that
there are particular dangers and hazards of combining more than one vaccination
in one or sequential administrations and some of those hazards and dangers are
not well understood and have not been fully researched, tested or proven safe
or effective.
10. I understand that individuals have different physiologies and that a
vaccination which may be harmless to one individual may be quite harmful to
another individual.
11. I am aware and understand that, prior to administration of any
vaccination, administrators of vaccinations must and shall disclose to all
interested parties all known and presumed risks, hazards, harm and failures of
vaccinations and all contents of the proposed vaccination/s including all trace
chemicals, adjuvants, components and contaminants whether or not administrators
consider those elements to be of consequence so that the recipients of
vaccinations can make fully informed decisions with regard to accepting
vaccination.
12. I am aware and understand that administration of vaccinations
without full disclosure and full voluntary consent of all interested parties
and imposing risk and hazard in that way represents criminal violation,
malpractice and major liability of the administrators of the vaccination to the
vaccinated party/s should any negative consequences arise.
13. I am aware and understand that any person who attempts to enforce a
“mandate” in forcing or coercing vaccination or any other medical treatment
upon any unwilling or uninformed party, whether or not that “mandate” is
provided in law, codes or regulations, is personally fully liable for any and
all harm, loss, damage, negative consequences of the vaccination upon the
vaccinated party and all other interested parties. That liability extends to
all administrators of that “mandate”, all legislators who were involved in the
creation of that “mandate” and all companies and individuals who promoted that
“mandate” through lobbying or other political action and all parties who
participate in the enforcement of the “mandate”.
14. I understand that, as an administrator or provider of any “mandated”
vaccination I am assuming all liability, obligation and responsibility for any
and all negative and/or unintended consequences of the administration of the
vaccine and that I must “make whole” the recipients of the vaccine, their
guardians, families and community for any and all financial and personal harm,
damage and losses caused by the vaccine and any and all harm which may be
reasonably attributed to the vaccine. I understand that this is necessary
because laws to not adequately protect vaccine recipients and, in fact, put the
public at risk of uninsured harm from vaccines.
15. I am aware and understand that I must disclose all risks of
vaccination prior to administration of the vaccine and, because vaccinations do
pose risks, I must allow the recipients, guardians and families to refuse the
vaccination at their sole discretion, and that disclosure of hazards and risks
does not absolve me from any responsibility, liability or accountability for
negative consequences of the vaccinations I administer.
16. If a person suffers any disease or injury at any time after
vaccination and not before vaccination and that disease or injury cannot be
affirmatively attributed to any particular cause other than the vaccination,
then I agree that it is reasonable to presume that the injury or disease was or
may have been caused by the vaccination and I will so presume and accept that
theory in the absence of compelling evidence to the contrary.
17. If the vaccine recipients, guardians, family members and interested
parties of the vaccinated party should, after the vaccination, submit claims
for harm, loss, damages, injuries or disease which they reasonably suspect to
be caused fully or partially by the vaccination, then the claims must and shall
be paid and delivered by the administrators of the vaccination (above) to the
claimant/s without challenge within 30 days from submission of each claim and
any challenge to the claim/s must be made through formal written process and/or
non-binding arbitration. Refusal or
obstruction of service of claim shall not reduce obligations and shall be cause
for escalated claim.
18. I am aware and understand that all administrators of vaccinations
are responsible for any emotional distress caused by their vaccinations and are
liable for compensation for such emotional distress caused to the
victim/s.
19. Administrators of vaccinations hereby agree that they will allow and
facilitate recording, videotaping, documentation and investigation of all
services, processes and facilities associated with the administration of the
vaccine and that administrators of vaccinations will not refuse or obstruct
that information gathering for any reason reasons such as “privacy,” “security”
or “proprietary.”
20. I am aware and understand that any failure or refusal to sign this
agreement causes suspicion of intention to do harm to the vaccinated party and
others and to avoid responsibility for potential harm that may be caused by
vaccination, and I am aware and understand that failure or refusal of signature
of this agreement by any administrator of vaccines is cause for rightful
refusal of vaccination by the intended vaccination recipient with law, code,
regulations, contracts and “mandates” notwithstanding.
21. Any threat of consequence for refusal of vaccination/s, such as
removal from school, quarantine, “child endangerment,” criminal prosecution,
“civil penalty” etc. is coercion, is offensive, inappropriate, unlawful and/or
violates parental rights. There is no law and can be no valid law which would
rightfully grant authority over any individual to determine medical treatment
for any other party who is in possession of their faculties. Refusal of
vaccination does not in any way imply poor judgment, diminished capacities or
social irresponsibility because there are extensive public records showing
harm, injury and death caused by vaccines.
22. I am / am not (circle one) claiming that I personally
have the right and authority to force medical treatment and vaccinations upon
the party (above) whom I intend for vaccination without his/her consent. If I
claim that authority, then I will provide all legal and official reference
which bestows that authority upon me specifically against the intended recipient
of the vaccination. I understand that I must provide evidence of authority to
the satisfaction of all interested parties before the person intended for
vaccination may be vaccinated because the interested parties presume that no
such authority exists nor can exist, and, in many cases, the harm caused by
vaccinations cannot be reversed.
23. I understand and agree that the person intended for vaccination is
not responsible to gather signatures on this form. The parties intending to
vaccinate must acquire and share this form, sign it and deliver it to any party
intended for vaccination upon request. At such time as the duly signed forms
are delivered to the person intended for vaccination, those agreement forms
will be signed by the person intended for vaccination or by his/her guardian
and one copy will be returned to each administrator of the vaccination/s. If
one of the requested administrators above fails to sign and return the form,
all agreements are void and vaccination is rightfully refused.
24. Refusal to sign this form is indication of deceit, bad faith and
hypocrisy on the part of a vaccine administrator who may recommend vaccination
as “safe”, but, at the same time, deny responsibility for the hazards. If
vaccinations are “safe” then refusal or hesitation to sign this form is firm
indication of misrepresentation with the assertion of “safety”.
If this form is refused or not signed by
any vaccine administrators listed above, then refusal of vaccine is rightful
and refusal must be presumed and honored. Vaccination does pose risks,
therefore administration of vaccine without signature on this agreement by all
parties called for herein or and/or without fully informed consent by all
interested parties constitutes criminal assault, malpractice, intentional harm
and violation of rights against the vaccinated parties and all other parties of
common interest by the administrators and providers of the vaccine whether any
harm is caused or not by the vaccination, therefore, without fully informed
consent by all interested parties, major obligations and liabilities arise from
non-consensual vaccination whether or not the vaccination causes physical
injury,r disease or other damage.
I agree that refusal to sign this form
constitutes admission and warning to the prospective recipient of vaccination
that vaccination may cause harm and should be avoided in order to protect the
health and safety of those receiving treatment.
Refusal by any administrator of a vaccine
to sign this form is grounds for the intended recipient of the vaccine and
their guardians to refuse vaccination pending the necessary safeguards and
insurance provided by the responsible party/s.
This agreement is separate and distinct
from any benefit/s, or “necessities” that may be attributed to vaccinations and
vaccination programs. The public may only protected when to do so does not
violate the rights of an indiviual.
Any vaccine which is not fully tested and
shown, by rigorous testing, trials, certifications and general administration
to be free of risk and which is accepted as such unanimously by the scientific
and medical communities, or which is not being administered and “mandated” by a
licensed physician to a consenting patient may not be administered lawfully or
without major liability and penalty for administering medicine without a
license and/or without the consent of the patient. Non-consensual medication
violates the United State Constitution, medical codes of ethics and a number of
international treaties and laws.
NOTICE: A
separate agreement must be signed for each individual intended to be vaccinated
and for each separate vaccine even if separate vaccines are “combined” in one
treatment.
By signing this form I agree to accept full
liability and be personally responsible for all harm, hazard and damage and
loss caused by the vaccine and vaccination which I am administering.
I understand that the intended vaccine
recipient accepts vaccination on the condition that it is proven safe and
effective to all reasonable expectation and insurance is provided to cover all
possible future claims of damage.
STATE ALL INGREDIENTS, ADJUVANTS AND
CONTAMINANTS IN THE VACCINE (PROVIDE ADDITIONAL SHEETS IF NECESSARY, PLEASE
SPECIFY PERCENT OR QUANTITY):
______________________________________________________________________________
______________________________________________________________________________
Signatures, identification and contacts for
responsible parties (vaccine administrators):
Authorized Officer of Vaccine Manufacturer,
Name:____________________________________
Title:____________________________________
Address:____________________________________
Phone:____________________________________
Driver's license
number:____________________________________
Alternate contacts and identification:____________________________________
SIGNATURE_____________________________________________
Authorized Officer of the Organization
Administering Vaccinations, Name:
_________________________________________
Title:____________________________________
Address:____________________________________
Phone:____________________________________
Driver's license
number:____________________________________
Alternate contacts and
identification:____________________________________
SIGNATURE_____________________________________________
Authorized and Accountable Officer of any
“mandating” government agency, Name:
____________________________________
Title:____________________________________
Address:____________________________________
Phone:____________________________________
Driver's license
number:____________________________________
Alternate contacts and
identification:____________________________________
SIGNATURE_____________________________________________
Individual Administering the Vaccination to
the Vaccine Recipients (Nurse, Healthcare Provider or
Other,
Name:____________________________________
Title:____________________________________
Address:____________________________________
Phone:____________________________________
Driver's license
number:____________________________________
Alternate contacts and
identification:____________________________________
SIGNATURE_____________________________________________
Elected officials, bureaucrats and
enforcement personnel supporting “mandate” of medical treatment and/or
vaccination (attache additional sheets as necessary):
Name:____________________________________
Title:____________________________________
Address:____________________________________
Phone:____________________________________
Driver's license
number:____________________________________
Alternate contacts and
identification:____________________________________
SIGNATURE_____________________________________________
Authorized Officer responsible for
distributing the Vaccination to healthcare facilities and providers:
Name:____________________________________
Print
name:____________________________________
Direct Contact information:
_________________________________________________________________________
_________________________________________________________________________________
Date:____________________________________
SIGNATURE_____________________________________________
When the party intended for vaccination is
able to confirm and assure the safety and effectiveness of the offered
vaccination, receives insurance or bonding for all possible harm and damage,
receives a complete list of all ingredients, adjuvants and contaminants of the
vaccination, and receives full identification and contacts of all responsible
parties (above) the party intended for vaccination will determine whether it is
appropriate, prudent, safe or necessary to provide consent to be vaccinated.
IF THE AGREEMENT ABOVE IS NOT SIGNED, the administrator offering or “mandating” a vaccine is required to
sign the following statement exclusive of all statements above:
I decline to sign the above agreement
because I am unwilling to accept personal liability for the harm, damage and/or
loss that my vaccine may cause.
Print
name__________________________________________________
Title_______________________________________________________
Address____________________________________________________
Phone
contact________________________________________________
Driver's License
Number_______________________________________
Date:____________________________________
SIGNATURE:____________________________________
