Your Body, Your Choice?
And so it arrives.
Flu shots for students. Who decides? The parents? The State?
If you believe the flu shot is not something you want injected into you or your child, please examine the documents linked below.
These documents do not constitute legal advice. These documents are advisory only. Use at your own risk.
These documents do not constitute legal advice. These documents are advisory only. Use at your own risk.
Vaccination Notice
Vaccination Notice
Notice to agent is notice to principal Notice to principal
is notice to agent .
As the parent of Sally Doe, I am prohibited by law from endangering my son or
daughter; therefore, I declare the following: Sally
Doe’s address: 2525 Maple Lane, Grove City, Massachusetts
1) I am aware that those ordering and/or administering
vaccines have been granted immunity from liability should my son or daughter
suffer from a vaccine-caused injury or illness. The Vaccine Injury Compensation
Trust Fund is not an acceptable alternative to me. (Reason listed below – #10)
2) Unless I receive the vaccine manufacturer’s package inserts,
I have not been given full disclosure regarding any vaccine. CDC or public
health vaccine information sheets and/or websites are not acceptable
alternatives. (Reason listed below – #4 & #5)
3) I am aware that vaccine schedules have been established
by the CDC and are promoted by public health departments, the American Academy
of Pediatrics and other organizations. I do not accept CDC recommendations as
science-based. (Reason listed below – #4 & #6)
4) I do not recognize the CDC as a government health
advocacy organization. It is a corporation listed on Dun and Bradstreet and
headquartered in the STATE OF GEORGIA, with strong ties to the pharmaceutical
industry. Therefore, their recommendations are influenced by the ‘fiscal’
health of their corporation.
5) I am aware that physician or institutional records are
frequently reviewed by the HEALTH, MASSACHUSETTS DEPARTMENT OF, a corporation
headquartered in BOSTON MA and listed on Dun and Bradstreet that receives
monetary compensation from the CDC to perform this function. Therefore, the
state public health department’s recommendations and actions are influenced by
the ‘fiscal’ health of their own corporation.
6) I do not recognize the AMERICAN ACADEMY OF PEDIATRICS nor
the AMERICAN ACADEMY OF FAMILY PHYSICIANS as health advocacy organizations.
They are both corporations (listed on Dun and Bradstreet) that are
head-quartered in the STATE OF ILLINOIS and the STATE OF KANSAS respectively,
whose monetary compensation from the vaccine manufacturers contributes to the
‘fiscal’ health of their corporations.
7) I am aware that many physicians are paid higher
reimbursement rates for administering vaccines.
8) I am aware that LEGISLATORS for the corporation known as
the COMMONWEALTH OF MASSACHUSETTS, listed on Dun and Bradstreet, vote on
statutes for the COMMONWEALTH OF MASSACHUSETTS. These include statutes
mandating certain vaccines for attendance in educational institutions. As the
LEGISLATORS have no medical training and can easily be influenced by drug company
lobbyists and/or the CDC, I do not accept their mandates as science-based. To
the best of my knowledge, I have signed no contract with
these LEGISLATORS. Therefore, their corporate vaccine
statutes do not apply to me or my son or daughter unless I consent to abide by
them.
9) I am aware of multiple scientific peer-reviewed papers
that have exposed the dangers of many vaccines as well as the “herd immunity
myth” of 1933.
10) I am aware that the corporation HEALTH & HUMAN
SERVICES, UNITED STATES DEPARTMENT OF (listed on Dun and Bradstreet and
headquartered in WASHINGTON DC) determines claims paid from the Vaccine Injury
Compensation Trust Fund via a secret administrative procedure and also profits
from vaccine patents.
11) I have concluded that failure to follow CDC vaccine
recommendations is less likely to endanger the health of my child or others
than following their recommendations. As parent or guardian, I am prohibited by
law to endanger my child.
So, for the reasons I have listed and more, I deny
permission for anyone to administer CDC recommended vaccines to my son or
daughter unless they provide me with the vaccine package insert, allow me to
determine if the health risks are acceptable, and sign a document stating that they
personally, not me, (and/or my spouse) will be responsible for any injury or
illness (as defined by the International Medical Council on Vaccination) the
vaccine they administer might cause.
NOTE: This document can be used to protect those that administer
vaccines (physicians, nurses or others) or are obliged to adhere to corporate
statutes (including educational institutions) from any punitive statutory
actions or penalties.
Parent/Guardian: Signature:
Date:
Parent/Guardian: Signature:
Date:
Witness: Signature:
Date:
Witness: Signature:
Date:
Agreement Between Vaccine Providers and Vaccinated Parties
Address:____________________________________
Phone:____________________________________
Phone:____________________________________
Address:____________________________________
Phone:____________________________________
Date:____________________________________
____________________________________
____________________________________
- AGREEMENT BETWEEN VACCINE PROVIDERS AND VACCINATED PARTY -
- NOTICES -
- NOTICES -
Herein the terms “administration” and “administrators” refers to all parties providing and/or “mandating” vaccine services and products including vaccine manufacturers, Distributors, Hospitals, Clinics, Physicians, Nurses, Government Agents and Agencies, Healthcare Providers and all other parties bringing 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. All of those parties are identified herein as:
Individual intended for Vaccination:____________________________________
Circle one: Adult Minor
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:____________________________________
and Vaccine Administrators (below)
Authorized Officer of Vaccine Manufacturer, Name:____________________________________
Title:____________________________________
Address:____________________________________
Phone:____________________________________
Driver's license number:____________________________________
Alternate contacts and identification:____________________________________
Authorized Officer of the Organization Administering Vaccinations, Name:
____________________________________
Title:____________________________________
Address:____________________________________
Phone:____________________________________
Driver's license number:____________________________________
Alternate contacts and identification:____________________________________
Authorized and Accountable Officer of any “mandating” government agency, Name:
____________________________________
Title:____________________________________
Address:____________________________________
Phone:____________________________________
Driver's license number:____________________________________
Alternate contacts and identification:____________________________________
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:____________________________________
I hereby agree to and with the following stipulations, terms, declarations and positions:
- I am aware and understand that vaccines are not a perfect or fully proven method of disease control.
- I am aware and understand that vaccines are not 100% effective.
- I am aware and understand that vaccines can cause injury and disease which seriously and negatively affects the lives of vaccinated individuals, their families and their communities.
- 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.
- I am aware and understand that vaccines cause risk which is the sole responsibility of the administrators and providers of the vaccine.
- 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.
- I am aware and understand that vaccinations do, on occasion, cause harm, injury and disease including the disease they are intended to prevent.
- 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.
- 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.
- 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 and components 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.
- 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.
- I am aware and understand that any person who attempts to enforce a “mandate” in forcing or coercing vaccination 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”.
- 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 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.
- 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.
- 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 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 undertaken to recover the payment and service through formal written process and/or legal action. Requests for recovery of claims paid must be supported by fact, evidence, law and moral cause. Refusal or obstruction of service of claim shall not reduce obligations and shall be cause for escalated claim.
- 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 to the victim/s.
- Administrators of vaccinations hereby agree that they will allow and facilitate recording, videotaping, documentation and investigation of all services and processes they administer to the vaccine recipient and that administrators of vaccinations will not refuse or obstruct that information gathering for such reasons as “privacy” or “security”.
- 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.
- Any threat of consequence for refusal of vaccination/s, such as removal from school, quarantine, “child endangerment” etc. is coercion, is offensive, inappropriate, unlawful and 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 or diminished capacities.
- 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.
- 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 in multiple copies 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 refused.
- 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”.
NOTICE: If this form is refused or not signed by all vaccine administrators 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 arise from non-consensual vaccination whether or not the vaccination causes physical injury or disease.
NOTICE: 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. This is separate and distinct from any benefit/s or “necessities” that may be attributed to vaccinations and vaccination programs.
NOTICE: A separate agreement must be signed for each individual intended to be vaccinated.
SIGNATURES OF THE AGREEING PARTIES
Individual intended to be Vaccinated:____________________________________
Print name:____________________________________
Date:____________________________________
Parents' or Guardian's Names and/or Head of Household (if different from above):
____________________________________
Print name:____________________________________
Date:____________________________________
Authorized Officer of Vaccine Manufacturer:
____________________________________
Print name:____________________________________
Date:____________________________________
Individual Administering the Vaccination to the Vaccine Recipients (Nurse, Healthcare Provider or
Other), Name:____________________________________
Other), Name:____________________________________
Print name:____________________________________
Date:____________________________________
Authorized Officer of the Organization Administering Vaccinations:
____________________________________
____________________________________
Print name:____________________________________
Date:____________________________________
Individual Administering the Vaccination to the Vaccine Recipients (Nurse, Healthcare Provider or
Other), Name:____________________________________
Other), Name:____________________________________
Print name:____________________________________
Date:____________________________________
Authorized and Accountable Officer of any “mandating” government agency:
____________________________________
Print name:____________________________________
Date:____________________________________
Individual Administering the Vaccination to the Vaccine Recipients (Nurse, Healthcare Provider or
Other), Name:____________________________________
Other), Name:____________________________________
Print name:____________________________________
Date:____________________________________
Best of luck!
No comments:
Post a Comment