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Family Financial Disclosure Form for COVID-19 Injections – English

QUESTIONNAIRE D’INFORMATION PREALABLE A DESTINATION DES FAMILLES – Francais

Finanz-Fragebogen für Familien vor einer Covid-19-Injektion – German

“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.

This form was created to assist families to communicate regarding and to prepare for the family-wide financial impact of adverse events, if any, resulting from a Covid-19 injection.

Examples of adverse events from Covid-19 injections include Covid-19 infection; anaphylaxis; neurological disorders; autoimmune disorders; other long-term chronic diseases; blindness and deafness; infertility, fetal damage, miscarriage, and stillbirth; and death (see Table 1 for examples of each).

Traditionally, informed consent forms for vaccination do not provide disclosure or statistics related to financial costs of possible injury, disability, or death, nor do they discuss the impact on family time, resources, health, and wealth—impacts that may include reduced career potential, divorce, and effects on siblings’ education and future plans.

Consequently, it is essential that prior to receiving a Covid-19 injection, parents and family members with financial responsibility for children and spouses not only perform thorough due diligence—providing adequate disclosures to their families regarding the potential costs to family members of adverse events or death—but also take steps to protect themselves and family members from the material adverse financial consequences of an adverse event or death.”

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Form for Employees Whose Employers Are Requiring Covid-19 Injections

“All over America, employees are facing a very tough decision right now. Although some wish to accept a Covid-19 injection, many do not. The problem is that a growing number of employers are trying to deny employees’ right to choose and their right to bodily integrity by requiring the vaccines as a condition of employment. In the United States and other jurisdictions, that is a violation of the law. It is also a violation of fundamental human and religious rights.

In the U.S., the provisions of the 2005 Public Readiness and Emergency Preparedness (PREP) Act and a February 2020 declaration by the Secretary of the Department of Health and Human Services (HHS) mean that pharmaceutical companies cannot be held liable for injuries or deaths caused by the Covid-19 injections.1 However, other companies, institutions, and individuals can be held liable. This form is designed as a tool that employees can use to provide this critical information to employers, and to insist on a signature from the employer’s representative that holds the company liable if the employee should decide to accept the required experimental Covid-19 injection.

We are already seeing that health care providers are refusing service to individuals injured by the Covid-19 injections, and health and life insurance companies are declining coverage for vaccine-related injuries and deaths on the grounds that the injections are investigational vaccines allowed under Food and Drug Administration (FDA) emergency use authorization (EUA) but not otherwise approved or licensed.²This denial of care and coverage poses a serious threat to the physical and financial well-being of employees presented with a requirement to get a Covid injection—perhaps even more so than the possibility of losing their job for not being vaccinated.“

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Forcing experimental “vaccines” on humans is a direct violation of the Nuremberg Code!!!
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COVID-19 Vaccine Declination Form

I have received a recommendation for COVID-19 vaccination to protect myself, my family, and other persons with who I may be working or residing. I understand that COVID-19 has caused a pandemic that involves risk to the health and life of individuals. I understand that in the absence of vaccination, I may acquire COVID-19 that may put my family, colleagues, friends, or persons around me at risk resulting in fatal consequences such as illness, disability, or death when exposed. In light of these matters, I have received information or educational materials with regard to the vaccine against COVID-19.

I have had the opportunity to ask questions and the answers were explained to me to my satisfaction. I understand that COVID-19 is a serious respiratory disease that has caused death globally. In case I have been exposed to an individual with COVID-19, I may be infected with it as well and spread the virus to the people around me.

However, it is my decision to decline the vaccination at this time, regardless of the information that I have received about its importance and the risk of not receiving it. I understand the consequences of my decision, including the continuity of risk of endangering my health and of others from being infected due to COVID-19. I understand that I may return anytime for receiving a vaccination, should I decide to receive it in the future as to its availability.

By signing this form, I hereby declare and acknowledge that I have read and fully understand the information on this declination form.

Name of Person : First Name Last Name

Consent: I am the above-named person signing this form. I am at least 18-years of age with full knowledge to the consequences of my refusal to receive the COVID-19 vaccine. I am the legal guardian/representative of the above-named person and I am signing this form on behalf of the above-named individual in acknowledging the decision in refusal to take the COVID-19 vaccine.

Signature of Person

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Vaccine Refusal Text

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OSHA Imposes New Guidance For Employer-Required COVID-19 Vaccines

”On April 20, OSHA released the new guidance in the frequently asked questions section of its website for COVID-19 safety compliance.

The question asks whether an employer should record adverse reactions to COVID-19 vaccination if the employer requires the vaccine. OSHA states that if a vaccine is required, then any adverse reaction is considered work-related and therefore it must be recorded. Under OSHA rules, most employers with more than 10 employees are required to keep a record of serious work-related injuries and illnesses. Recorded injuries and illnesses become part of a contractors safety record.”

Source Article

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Research if in the country in which you reside, if you can legally reject a medical treatment. Some people can reject a medical treatment under their own responsibility.

Research if your nation’s Constitution brings you freedom over your body/body autonomy, allowing freedom of choice about medical treatment.

If you are being coerced or forced to take the experimental COVID-19 gene modification injection and need legal help to fight this violation of your rights and liberties, then please feel free to contact this office at 281.698.8698. A staff member will give you the name of an attorney who will fight to defend your rights and stop the coercion to become vaccinated.

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COVID QUIZ (20 Questions)

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“Responsible person” is the person forcing a person to wear the mask, which could be a security guard at a store, a store manager, a supervisor, etc. It is meant to make that person aware that he/she will be held accountable for his/her actions of forcing the mask wearing & any consequences that occur as a result.

“Issuer of Notice” is the person who is not wearing the mask and using this document to receive an exemption from any mask wearing requirement.

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If your children’s school or your employer are planning on mandating the vaccine, know your rights.  Visit the legal team at frontline doctors, and click on the “vaccine public letter”

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An Urgent Statement to Lawmakers:
from Peggy Hall

Forcing a medical experiment upon an individual as a condition to participate in society is illegal, unlawful and immoral and reprehensible and it is a violation of our God-given, Natural, and Common Law rights, as expressed and confirmed in the American Declaration of Independence, and as reflected in the constitution of this state and the constitution of the United States.

We know what you’re doing.

1. There is no emergency. There never has been one. The numbers don’t support it.

2. You are perpetuating the notion of an emergency to get money, to impose tyranny and to unlawfully force medical experimentation upon the populace. This so-called vaccine has only gotten an emergency use authorization under the guise of an emergency; otherwise the EUA is null and void (by the way, masks and covid tests are EUAs as well.)

3. Even if this could be called an emergency, no emergency suspends one’s rights. Rights cannot be taken from you.

4. You are perpetrating fraud, and fraud is a felony and a felony carries a prison sentence. You are hereby notified that if you engage in harassment, intimidation and/or retaliation against any member of the public including me, for this statement of truth, such actions will be reported to the FBI.

It doesn’t matter whether vaccines work or not.

It doesn’t matter whether this is even a vaccine or not.

What matters is that each individual has sovereignty and authority over their own body.

We know what you’re doing.

We know exactly what you’re doing.

You are having your puppet strings pulled to float a trial balloon about this unlawful vaccine passport, which he now is calling a vaccine verification.
Next will come the statement that it’s not the government that is requiring it, but the businesses.

Much like how you’ve kicked the can down the road to cover your own tail while endorsing corporate fascism, where the United States of Costco is now making and enforcing laws.

Here’s the real truth:

These so-called vaccines can never be required as a condition for commerce.

Among many laws that protect individuals from the excess power of government tyrants, here are three…

1. EMERGENCY USE AUTHORIZATION LIMITATIONS on All COVID-19 vaccines, which are under an Emergency Use Authorization (EUA) and cannot be made mandatory.
On its website, the U.S. Food and Drug Administration (FDA) notes the following: “…Recipients must be informed… that they have the option to accept or refuse the vaccine .”

 2. Forced vaccination violates the right to privacy, which is protected, secured and guaranteed by the 4th Amendment of the US and the constitution of this state. The Othena website that is to track the vaccine verification requires a plethora of one’s personal information.

The Othena.com website states it collects the following information:

Name email, Id, mailing address, phone number, date of birth, access to your CAMERA, all Photos, all images, all audio, files video and other details.

https://curapatient-webapp.s3.amazonaws.com/data/privacy.pdf

3. Forced vaccination is unlawful DISCRIMINATION, discriminating against those who have cell phones or want to participate in AI.

Further, forced vaccination is a violation of:

  (A) CA GOV Code 51, which protects FREE AND EQUAL access to ALL PUBLIC ACCOMMODATIONS.

Public Accommodations are “private businesses engaged in commerce.” That means retails stores, banks, restaurants, recreation, transportation – and entity, location or establishment that is open to the public is prohibited from discriminating against the entry of a member of the public.

 (B) CA GOV CODE 12926 (q) protects one’s religious liberty and practice, including the ability to NOT PARTICIPATE in practices that violate one’s sincerely held religious beliefs 

 (C) CA GOV CODE 37100 – prevents any creation, application or enforcement of a law or policy that violates the California Constitution or the Constitution of the United States.

Every time I address this board, I end up educating you on the laws you have sworn to uphold.

Absolutely astonishing. Your ignorance is astounding.
You are either ignorant, incompetent, or intentionally deceiving the public.

But we see right through it.

WARNING TO ALL GOVERNMENTAL, PUBLIC AND PRIVATE ENTITIES AND PERSONS

Based on the above, and on behalf of all those named and referenced herein:

(a)   No business or organization, including any governmental agency has the authority to force me or anyone else to take any and all COVID-19 vaccines, as well as any other vaccine;

(b)  No business or organization, including any governmental agency, has the authority to deny me any and all services provided to COVID-19 vaccinated individuals;

(c)   Denial of any such services, will be a violation of our God-given, Natural, Common Law, state and federal constitutional and international rights not to be vaccinated in any way or form without our consent, this includes our right not to be tracked based on our vaccination status; and

(d)  Any such government agency, business or organization, person’s acting as offices of such entities, man and/or woman, violating our right not to vaccinate against COVID-19 will be liable under tort law and for deprivation of rights under color of law, and will be subject to lawsuits, accordingly.

A tort, in common law jurisdiction and otherwise, is a civil wrong that causes a claimant to suffer loss or harm, resulting in legal liability for the person who commits the tortious act. It can include intentional infliction of emotional distress, negligence, financial losses, injuries, invasion of privacy, and many other things. In summary, no COVID-19 vaccination can be required in order to operate in community and social life, whether it is to go shopping, to work, to visit recreational areas, to visit persons in medical establishments, to travel, to visit restaurants or any business, or to enjoy are God-given right to go about our lives without government or corporate interference.

Failure to respect this, and any intent to violate anyone’s right not to receive any vaccine for COVID-19 or any other disease may and will result in legal action against those involved:

(1)  In the case of government officials, coercing and forcing any person to take such vaccines is a violation of your Oath of Office, your obligation to protect our constitutional rights, and will strip you of any and all governmental immunity for acting outside of your authority; and

(2)  In the case of any business and organization, man or woman, coercing and forcing any person to take such vaccination in order to provide any services or to provide access to your establishment, will be considered a violation of constitutional rights, subjecting your business or entity, and you as a private citizen, a man or a woman, to legal action against all of your assets. Business and organization policies are not above the law.

LEGAL NOTICE: If I am compelled or forced to vaccinate to receive your services and I am injured, it will be considered coercion, duress and against our will, and you will be held liable for any such injury. I note here that we are not refusing vaccination, we are simply declining such vaccination for the reasons noted herein, and as mandated by God, the highest legal authority.

— Peggy Hall, Founder, THE HEALTHY AMERICAN

Document found here.

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Notes from Expat Gal:

– I will continue to look for resources you can share with family & friends to help them make an educated decision regarding the COVID “vaccines”.

– Please click through to the first form & read through this. It is a very useful way to make some way who is unable to see that there may be dangers and negative consequences associated with these so called vaccines. Many key points (I.e. new technology, past failing of mRNA technology, scope of adverse reactions, gene therapy versus a traditional vaccine, etc.) are all contained with digital links to much more information! Make those you love considering the vaccine, read it & sign it. It will make them much more aware of what these “vaccines” truly are, their dangers, the possible negative outcomes from taking these “vaccines”, etc. It will be the type of INFORMED CONSENT that is missing globally for people taking these “vaccines”. We must do everything in our power to stop the destruction of people’s immune systems & the significant reduction in their life span that is predicted by multiple doctors, biologists, scientists & immunologists around the world!

– Just a note that these forms will likely have a limited timeframe for being useful. When the vaccinated (which are predicted to be the third wave – next post – begin dying), expect the BLAME to be squarely placed on the UNVACCINATED. These forms will be less useful as panic and illogical thinking & behavior sets in.

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