So, today, someone pointed me to this form that the American Academy of Pediatrics presents to have patients sign for “Refusal To Vaccinate”. (Form is linked within this text, but I have screen shots also, should they remove it, or change the form.)


I’m going to address some highlights here (I could do a 4 hour workshop on this form), so that you can see that the American Academy of Pediatrics (AAP) apparently doesn’t give ONE DAMN about you, your child, or your safety.

This entire article, and any ancillary attachments links, or whatnot that I point to other than the AAP form is absent intent or authority as legal advice, and is presented as educational, informational, and for entertainment purposes only.

The AAP paperwork starts of with a feel good statement: “All parents and patients should be informed about the risks and benefits of preventive and therapeutic procedures, including vaccination.” “Risk” is a word that is repeatedly used on this document, and the form that accompanies it. But, the risks are not listed on this form. Those same risks, are acknowledged by the patient’s signature on this form, however. This is legal suicide, in my opinion. Acknowledging risks that are alluded to, yet not listed, is saying “Fuck me hard without lube.”

Risks are supposedly listed on a Vaccine Information Statement (VIS) which is supposed to accompany this paperwork. PROBLEM: It is prepared by the Centers For Disease Control (CDC), and is thus suspect, in my opinion. This is the same goddamn entity that is allowing the injury to continue without holding the manufacturers accountable. And, if there is a pandemic, it is of vaccine INJURY, not vaccine refusal.

The main risk that is not listed, nor mentioned on this form is that the manufacturer is covered and shielded from liability under the NCVIA (The National Childhood Vaccine Injury Act (NCVIA) of 1986)

Any injury from a vaccine can not be pursued directly against the manufacturer. This means that the manufacturer is putting out a product that it DOESN’T HAVE TO be liable for the safety of said product.

Let us end thisThe entire AAP paperwork package above appears to be solely to cover the doctor’s ass, but it’s uses are more disturbing.

It can be used as evidence against the parents to pursue negligence claims.

For instance:


“I understand the following:
  • The purpose of and the need for the recommended vaccine(s).
  • The risks and benefits of the recommended vaccine(s).”

Really? Well, apart from the matter of “understand” being a magical legal word that includes a meaning of agreement, the inferred purpose of vaccines is to provide immunity, but where is the guarantee of immunity? And the “need” for the recommended vaccine – who “needs” a product that is not 100% safe and 100% guaranteed, and whose manufacturer doesn’t stand liable for the safety of said product 100%?

Understanding the risks is another minefield. I would posit that one CANNOT understand the risks, as they are not fully admitted. nor is the meanings of the words used clearly and completely listed in a glossary that is readily available, to my knowledge. I had a vaccine reaction that was brutally harsh years ago, because of a job that I was doing and they recommended it. When I showed my reaction to the doctor, her response was that it had to be something else. This is STANDARD OPERATING PROCEDURE. DENY, DENY, DENY causality.
Risk. The doctor covers his ass with malpractice and other forms of insurance. Did he likewise advise the patient to cover themselves and their children with insurance that would cover monetarily if a vaccine injury occurred? (I have no clue if this exists, or if an underwriter would even attempt such a thing, since the market is so full of lies on this subject matter).

Understanding the risk is admitting that, IF a child is injured, the injury claim will be limited to what the VAERS system allows for a payout.

The next column that lists possible consequences of NOT vaccinating, should actually be the possible consequences of vaccinating. Damn. This is only meant to damn the parent in writing, should they sign this document. What court would hold a parent fit after signing such a damning admission? LEGAL MAXIM: ADMISSION TRUMPS EVIDENCE, and the fact that the parent signs, means no proof of cancer, death, paralysis, brain damage, etc., need be produced, since the agreement is signed, and thus fully admitted as truth.

“Transmitting the disease to others” MEASLES VACCINE DOES THIS! Shedding occurs!

“may endanger the health or life of my child and others with whom my child might come into contact.” This is a liability statement, and shows apathy concerning the alleged possibility that the child’s health may be endangered (according to their allegations). Signing this is a damning confession of negligence and apathy as a parent, in my opinion.

QUOTE: “I therefore agree to tell all health care professionals in all settings what vaccines my child has not received because he or she may need to be isolated or may require immediate medical evaluation and tests that might not be necessary if my child had been vaccinated.”

THIS IS A WAIVER OF THE RIGHT TO PRIVACY. YOU have a right to remain silent on the matter of vaccines. “Are you up to date on all your vaccines?” Is a question you do NOT have to answer. PERIOD. And the above document waives the right to privacy by this agreement to tell vaccination status. BULLSHIT.

QUOTE: “I know that I may readdress this issue with my child’s doctor or nurse at any time and that I may change my mind and accept vaccination for my child any time in the future.”

Well, now, this is interesting, because it acknowledges that one may change their mind…

Should there have been the advice to seek legal counsel before signing this document? Well, yes. This document confirms it.

which clearly states: “The AAP Refusal to Vaccinate Form, which should not be considered a legal document without advice from a lawyer, may be used as a template for documentation of parental refusal.”
They have admitted that there is a need for legal advice before the refusal form should be considered a legal document, and yet they don’t advise the parent/patient of this on the actual form. THIS IS BULLSHIT, SHADY AS FUCK, AND OUTRIGHT EVIL, in my opinion.

If this form is something you have signed, perhaps it’s time to revisit it in writing, with registered mail, so that there is a documentation of the process.Doctors should be receiving a “ACCEPTANCE OF FULL LIABILITY FOR VACCINE INJURY” Form, and a “REFUSAL TO ACCEPT FULL LIABILITY FOR VACCINE INJURY” Form, and be asked to choose between the two… (Yes, this is how I roll)


Any and all words, terms, and their meanings as used in this article are without waiver of the right of interpretation by PRIVATE SOLUTIONS, PMA.