Liability Waiver and Informed Consent
- Please provide the approved legal status of any vaccine and if it is experimental.
- Please provide details and assurances that the vaccine has been fully, independently and
rigorously tested against control groups and the subsequent outcomes of these tests.
- Please provide the ingredients of the vaccines and if any are harmful to the body.
- Please fully advise of all the adverse reactions associated with these vaccines since their
- Please confirm that the vaccine you’re recommending is not experimental, mRNA and gene
- Please confirm that I won’t be under any duress in compliance with the Nuremberg Code.
- Please confirm the likely risk of fatality should I contract COVID-19 and the likelihood of recovery.
Once I have received the above information in full and I am satisfied that there is no threat to my
health I will be happy to receive the treatment, but with certain conditions.
- A confirmation in writing that I will suffer no harm, adverse reactions to the vaccine.
- Following acceptance of this (1). The offer must be signed by a fully qualified doctor who will take
full legal and financial responsibility I incur due to this treatment and/ or any interactions by
authorized personnel regarding these procedures.
- In the even that I decline vaccination, please confirm that I will not compromise my position and
will not suffer prejudice and discrimination as a result. I would also advise that my inalienable rights