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- documents -
The purpose of Acceptance of Responsibility documents is to make the doctor or other vaccine promoting individual aware that you are aware of the dangers of vaccination and that you insist that the promoters accept the responsibility that they so easily expect you to bear.

Please read the "Your Choice" linked material here:
It is important to note that this document has never been signed by a physician as far as we know. (12 June 2012)

Even more important is the recognition that
  - if your doctor does sign an Acceptance of Responsibility document
  - and you allow your child to be vaccinated
  - and as a result your child is vaccine damaged,
it is very unlikely that any court in the USA in our present legal climate would honor your claim against the doctor.

We at VacLib are not lawyers, but the current laws regarding the federal vaccine court (NVICP) may (?) nullify such a contract.

Note: Some states, I.E. NY, require exemption requests to be in the applicants own words. It is important that you do not use our samples with out changing the language into your own wording. That means you may take out certain concepts and perhaps add something more applicable to your belief system.

Our newest, longest and best document is here:
Physician's Warranty of Vaccine Safety
MS Doc file that you can modify and print [consent09.doc]

An older form in HTML format that you can copy and paste

Sample letter to refuse employer mandates

With reasons and references why vaccines are dangerous

Dr. Moulden created a liability form and posted it on VIC (Vaccine Injury Coalition) website:

NJ Refusal Letter and information

Consent to Vaccination: (Text Files)
Consent to Vaccination, physician's consent to responsibility. .TXT 2K

Immunization Indemnification Certificate .TXT 4K

Page of links to forms and flyers

OSHA & HEP-B: "They have to provide you a declination form - 29 CFR 1910.1030, Appendix A,"
from well-within site:

Reason for forms:

The most frequently asked question VacLib receives these days is how to deal with a school district, daycare or employer who insists that you or your child must have a particular shot or shots in order to continue employment or participation in the daycare or school program.

It is absolutely vital that you are prepared to deal with this situation without acquiescing to forced medical experimentation. If you are in a state that does not have a philosophical or personal conviction exemption to vaccinations, or other state enforced treatment with psychiatric drugs, it is imperative that you use these two forms as a template in creating your own form for the bureaucrats or doctors enforcing or administering the particular drug to sign.

If they refuse to sign it, tell them that you have knowledge of a person that is permanently disabled as a result of the Hepatitis B vaccine (the most frequent requirement for healthcare employment.) This person you know of is currently unemployed and has not received any just compensation for their injury, forcing them into abject poverty.

Insist that this form is strictly for your protection so that you do not end up in the same predicament. If the risk of an adverse reaction is as rare as they want us to believe, they should have no problem playing Russian roulette and signing the form. Afterall, you are being coerced into playing Russian roulette with your health!