Letter of Conditional Acceptance NHS Professional
Please feel free to download (above) and use this template letter between Vaccine Providers and Vaccinated Parties - Notices & Conditional Acceptance - Open Letter
- AGREEMENT BETWEEN VACCINE PROVIDERS AND VACCINATED PARTY -
- NOTICES AND CONDITIONAL ACCEPTANCE - OPEN LETTER -
Letter of Conditional Acceptance/Consent to Doctor/Health Professional pursuant Article 6 Universal Declaration on Bioethics and Human Rights (UDBHR) 2005 and Data Subject Access Request pursuant Article 15 General Data Protection Regulation (GDPR) re: Offer of SARS Cov-2 Injection. The Nuremberg Code 1947 Article 6.
Date: ............................
Dear Doctor/Health Professional
I/We are writing to notify you that, I/we shall only offer our Conditional Acceptance/Consent to be vaccinated/injected with the SARS-Cov-2 injection upon condition that the answers to every single question set out below is in the affirmative and all reasoning requested supplied to us by ……………….
i.e. Before 3rd February 2022 (please edit as required) or as soon as reasonably practicable.
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. Those parties are identified herein as:
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: ____________________________________
and Vaccine Administrators (below)
Authorized Officer of Vaccine Manufacturer:
Name: ____________________________________
Title: ____________________________________
Address: ___________________________________________________________
Phone: ____________________________________
Driver's license number: ____________________________________
Alternate contacts and identification: ____________________________________
Authorised Officer of the Organisation Administering Vaccinations,
Name: ____________________________________
Title: ____________________________
Address: ____________________________________
Phone: ____________________________________
Driver's license number: ____________________________________
Alternate contacts and identification: ____________________________________
Authorised 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 as a Medical Doctor/Health Professional ……………………………... as laid out by the General Medical Council (GMC), 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 Covid-19 vaccines have not been fully tested enough to show that they are 100%
safe and Effective, but I can provide the Risk Assessment that shows a full health and safety
evaluation of the risks associated with the stated SARS Cov-2 vaccine/injection.
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 also cause major costs to individuals, families and communities, costs of which 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 risks which is the sole responsibility of the administrators and providers of the vaccine. I have first-hand knowledge that satisfies me beyond reasonable doubt that the SARS Cov-2 vaccine/injection is sufficiently safe and effective for mass roll-out without a marketing licence.
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 increases the chances 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 fully 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 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. Furthermore, I shall provide ‘In Full’ the necessary Risk Assessment on the Human Experimental Vaccine Clinical trial, (of which is still in trial stage three until 2023), as required under English and International Law, including and not limited to the Nuremberg Code 1947 Article 6.
Full disclosure will include that Human Experiments must be based on previous animal
experimentation, as required by third element of the Nuremberg Code 1947.
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 do 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 discretion1, and that disclosure of hazards and risks do 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 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.
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 to the victim/s.
19. 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
1 Even if the necessary documentation requested is received and satisfactory, it is the individual’s Human right and discretion to decline, if they so wish.
information gathering for such reasons as “privacy” or “security”.
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. I/we do agree/disagree (circle one) that any threat of consequence for refusal of vaccination/s, such as removal from school, quarantine, “child endangerment” etc. is coercion, is offensive, appropriate, 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 judgement, diminished capacities or social irresponsibility.
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, as authorised and consented by that recipient. 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 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 fail 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”.
25. I understand and agree that the vaccinated party cannot make any claim, from any life insurance policy which will not cover, adverse reactions from any given Covid-19 vaccines, vaccine damage, or even death as a result.
NOTICE: 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 honoured. 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 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: ____________________________________
Name: ________________________________________
Print name: ____________________________________
Direct Contact information: _________________________________________________________
_____________________________________________________________________________
Date: ____________________________________
Parents' or Guardian's Names and/or Head of Household (if different from above):
Name: ____________________________________
Print name: ____________________________________
Date: ____________________________________
Authorised Officer of Vaccine Manufacturer: ____________________________________
Name: _________________________________________
Print name: ____________________________________
Direct Contact information: ___________________________________________________
___________________________________________________________________________________________________
Date: ____________________________________
Authorised Officer of the Organisation (clinic, hospital or office) Administering Vaccinations:
Name: ____________________________________
Print name: ____________________________________
Direct Contact information: ____________________________________________________________________
___________________________________________________________________________________________________
Date: ____________________________________
Individual Administering the Vaccination to the Vaccine Recipients (Nurse, Healthcare Provider or
Other), Name: ____________________________________
Print name: ____________________________________
Direct Contact information: ____________________________________________________________________
___________________________________________________________________________________________________
Date: ____________________________________
Authorised and Accountable Officer of any “mandating” government agency or program:
Name: ____________________________________
Print name: ____________________________________
Direct Contact information: ____________________________________________________________________
___________________________________________________________________________________________________
Date: ________________________
Authorized Officer responsible for distributing the Vaccination to healthcare facilities and providers:
Name: ____________________________________
Print name: ____________________________________
Direct Contact information:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Date: ____________________________________
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