12 Reasons To NOT Sign The Refusal To Vaccinate Form

by Shelby

Due to the growing number of parents who have done their research and opted out having their children vaccinated, the CDC developed the “Refusal to Vaccinate” form. According to the CDC, children must receive 37 doses of vaccines from 0-16 years of age. While a refusal form would appear to be innocent enough, the opposite is true in this case. There are many reasons to not sign this form, and we have compiled a list of 12.

1. Listed on the document is a child ID number that can be identified through electronic records systems across the nation. Any government agency or school will be able to use the number to identify who is or isn’t vaccinated.

2. Terms are changed up for the HPV vaccine, in order to sway parents into allowing their child to have the dangerous Gardasil vaccine.

3. Vaccination histories are used as a part of the Police State Registry system that tracks our vaccination status.

4. The CDC Vaccine Information Statement is propaganda in its purest form. The Health Hazards of Disease Prevention (2011) was a paper which exposed this exact vaccination information coverup.

5. The form is misleading in reference to the CDC’s procedure of providing truthful vaccine risks. Physicians keep pamphlets and information in their office regarding the risks of the vaccines, but typically do not explain said risks during the procedure. Why? Because they know that if you were fully informed, that you would not take the vaccinations.

6. “I understand the following: The risks and benefits of the recommended vaccine(s).” If you agree to this statement, you are lying. There is not a way to understand the risks or benefits unless you have read the package inserts. There is quite a bit of necessary information that is left out of the inserts as well, which really has to make you question exactly how much you truly do understand.


7. The CDC pushes the vaccinations on children by telling parents that without the vaccine their children could suffer from deadly illness. However, what they don’t tell you is about the diseases or health issues you could suffer from by taking their vaccinations.

8. If you refer to the “herd immunity myth” of 1933, you would notice that there is no scientific basis for said myth and that it has been proven as false over and over again. Basically, if other children have had their vaccines, and the vaccinations work, they will not contract a disease from your child.

9. There are entities listed who “strongly recommend” the vaccination schedule. However, it is important to note that parents are not told who these entities are or what their motivations are. Listed on the form are the following entities and brief descriptions of their motivations.

  • The ‘physician’ – is rewarded for administering vaccines by higher reimbursements for his fees. His vaccine “rates” are checked to determine whether or not he/she is entitled to more money. Physicians, public health workers, and drug companies have all been given immunity from any possible lawsuits that may arise as a result of vaccine-caused injury or illness. In other words, if a vaccine harms your child or causes autism you cannot sue any of them. They all have a liability exemption.
  • The American Academy of Pediatrics which is a corporation headquartered in the STATE OF ILLINOIS – that receives lots of money from drug corporations for advertising in their journal, etc. This organization relies heavily on what they falsely believe to be a “government” health advocacy agency known as the Center for Disease Control (CDC).
  • The American Academy of Family Physicians which is a corporation headquartered in the STATE OF KANSAS – that also receives lots of money from drug corporations for advertising in their journal, etc. This organization also relies heavily on what they falsely believe to be a “government” health advocacy agency known as the Center for Disease Control (CDC).
  • The Center for Disease Control (CDC) which is a corporation headquartered in the STATE OF GEORGIA. The CDC IS NOT PART OF A LEGITIMATE GOVERNMENT. Repeat: the CDC IS NOT PART OF A LEGITIMATE GOVERNMENT! It is a private for-profit corporation listed on Dun and Bradstreet that is chartered under the umbrella of the private for-profit UNITED STATES corporation with extremely close ties to the pharmaceutical companies and a sordid history of corruption.

10. This is possibly the worst part of the entire form. When you read the words, you will see why, but basically, it is you saying that because you chose to not vaccinate your child that you are endangering their lives and the lives of others.

“Nevertheless, I have decided at this time to decline . . . I know that failure to follow the recommendations about vaccination may endanger the health or life of my child and others . . . I, therefore, agree to tell all healthcare 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.”

11. By signing the form, you are admitting that you understand the document entirely. If you sign the form, you are accepting false information. You are saying that you are negligent and that you are ok with your children being tracked by the government.
When you sign it, you are pledging the following:

  • You understand you are signing a contract with performance requirements
  • You accept false information as factual and don’t care
  • You don’t care if your child or others are harmed by your decision
  • You agree to volunteer to all pretend healthcare workers your child’s vaccine record
  • You agree to allow others to test and/or isolate your child for unproven exposure to a disease

12. To make matters worse, you sign, initial and date the form in front of a witness, so if a custody dispute ever occurs, the form could be used against the parent who signed it.

Of course, when physicians are told that they must force you to sign the form, they are told that parents can come back and sue them if their children end up sick due to lack of vaccination. Scare tactics are used against them, to have them use scare tactics against you, and the cycle goes on and on and on. Instead of having parents sign the Refusal to Vaccinate form, they should use the Vaccination Notice. The notice corrects misconceptions regarding vaccines, as well as the herd immunity myth, and the CDC.

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