Page 52 - Summer2015

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 is: 2525 Maple Lane, Grove City, Ohio
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. Since the Supreme Court decision Bruesewitz v. Wyeth (Feb 22, 2011), drug companies
are under no legal obligation to insure their vaccine products are either safe or effective. 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. (Reasons 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. (Reasons 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 influ-
enced by the “fiscal” health of their corporation.

5) I am aware that physician records are reviewed by the Ohio Department of Health, a corporation headquartered in Columbus, OH
and listed on Dun and Bradstreet, and which 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 corporation.
6) I do not recognize the American Academy of Pediatrics nor the American Academy of Family Physicians as health advocacy organiza-
tions. They are both corporations (listed on Dun and Bradstreet) that are headquartered 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 state of Ohio, listed on Dun and Bradstreet, vote on statutes and rules
for the state of Ohio. These included statutes mandating unsafe pharmaceutical products called vaccines for attendance in education
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 corporate statutory mandates as science-based.

9) I am aware of multiple scientific peer-reviewed papers that have exposed the dangers of many vaccines as well as the “herd im-
munity myth” of 1933.
10) I am aware that the corporation U.S. Department of Health and Human Services (listed on Dun and Bradstreet and headquartered
in Washington, DC) determines claims paid from the Vaccine Injury Compensation Trust Fund via a secret administrative process and
also profits from vaccine patents.

11) I have concluded that failure to follow the CDC recommendations about vaccination is less likely to “endanger the health or life
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 the 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 from any punitive statutory actions or penalties.

Parent/Guardian: Signature: Date:
Parent/Guardian: Signature: Date:
Witness: Signature: Date:
Witness: Signature: Date:
52 Wise Traditions SUMMER 2015 Wise Traditions

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