The following forms are provided to help families, employees, students, and parents successfully implement complete due diligence and informed consent with respect to COVID-19 injections. We are currently reviewing possible updates based on President Biden’s announcement of federal mandates. We are waiting for the actual federal position and directions to employers to be published by the Department of Labor. We continue to follow legal positions from Governors and State Attorneys General who will take the position that such mandates are not legal or enforceable in their states. Please make sure you investigate the specific legal treatment and enforcement practices within your particular state and local jurisdictions regarding mandates and exemptions.

For Family Members: Updated: June 2022

Family Financial Disclosure Form for COVID-19 Injections

The goal of this Family Financial Disclosure Form is to ensure that an adverse event or death of one family member does not translate into long-lived or permanent financial destruction for the entire family.

For Employees

Employer Disclosure Form for COVID-19 Injections

This is a form every employee who is faced with this situation needs to submit to the authorized officer of their company. It is requires them to respond to your questions (already on the form for you), provides you with requirements by the FDA, makes them review the ways they are breaking the law or ethical principles related to human experimentation and choice, and holds them 100% financially responsible, requiring a signature.

For Students

School Disclosure Form for COVID-19 Injections

This is a form every student who is faced with this situation needs to submit to the authorized officer of their school. It is requires them to respond to your questions (already on the form for you), provides you with requirements by the FDA, makes them review all of the ways they are breaking the law or ethical priniciples related to human experimentation and choice, and holds them 100% financially responsible, requiring a signature.

For Parents

Notice and Declaration of Parental Authority Requirement of Disclosure and Safety of Medical Treatment/s

This is a form that parents can use to notify relevant parties that they do not give consent to their child being administered a COVID-19 injection without the parent’s express written informed consent. It states that no such consent will be considered without a detailed response to a series of questions.

Other Languages and Jurisdictions

The Family Financial Disclosure Form for COVID-19 Injections has been adapted for other languages and jurisdictions. See the following links:

Related Reading:

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Emergency Campaign to Stop All COVID Vaccination Mandates

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Letters from Children’s Health Defense: Notice for Employers, Universities and Other Institutions Mandating COVID-19 Vaccines

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