If I may ...
I have been forced to get the vaccine at work or lose my job I have been here to long to leave and start over and I am only a few years away from retirement
Adjust certain words to your situation. And/or edit to your liking. Create the proper signature lines, etc.. Really try this. It can't hurt. Make two copies and have both signed, leave one with them. If they agree; Ensure that they sign first, and you second.
Granting or Withholding of Informed Consent
Acceptance of Full liability.
To whom it may concern,
I write with regard to the matter of the covid vaccine being a condition of my employment and my desire to be fully informed and appraised of ALL facts before going ahead and having it administered on my body. Medical interventions and any treatments being a private matter. Obviously, there are tensions rising around the world over this being made mandatory - and frankly, they are highly unnecessary, since the principle of informed consent reigns supreme (in accordance various Federal and State laws that protects ALL people from harm). I want to start by making it crystal clear, I am not anti-vaccine!
In preparation for this time in history, and realizing that we're all in this together - and we all need to do what we can, I have familiarized myself with the information I need to be able to, grant, or withhold, my consent, and in my search to have these questions answered, since the release of the vaccines under the FDA's Emergency Use Authorization, and the possible near future FDA rushed approval, the vaccine manufacturers and officials, both in government, and in the medical community, have not provided this information nor fully disclosed all the necessary information to come to any conclusion.
It may be because they are absolutely overwhelmed with dealing with the pandemic from a much higher perspective, which is understandable; who am I to be able to get an answers in a timely fashion? But since these health and government officials are making these recommendations to corporations, I am sure they would have forwarded you the required information that makes someone's consent a fully informed decision.
The execution of this document, and acceptance related hereto, shall not be deemed to be a waiver of any my rights, which are reserved, without prejudice, and as such, the Corporation agrees that the rights and remedies of the employee hereunder are in addition to their rights at Law or equity. In order for my consent to be informed, I require:
1. The approved legal status of any vaccine and if it is experimental, investigational, and/or mRNA technology or not.
2. Details and assurances that the vaccine has been fully, independently, and rigorously tested against control groups and the subsequent outcomes of those tests.
3. The full list of contents, (ingredients), by weight, volume, or fluid measurements, of the vaccine I am to receive and if any are toxic to the body.
4. A comprehensive database of any and all reported adverse reactions associated with this vaccine since its introduction.
5. That the vaccine you are advocating is NOT experimental nor, "investigational", and/or mRNA gene therapy or cell altering therapy?
6. That you are not using coercion, as my employers, to force myself, in compliance with Federal and State coercion laws, into getting this injection.
7. Should I be unfortunate to contract SARS-CoV-2, what is the risk of fatality, and what is the likelihood of recovery?
Once I have received the above information in full and I am satisfied that there is NO threat to my health, physical, mental, or otherwise, I will be happy to accept your offer to receive the injection, but with certain non-negotiable conditions - namely that: As the vaccine manufacturers, and administering medical health care personnel, are legally exempt, have legal immunity, from all financial and legal liability, personally or otherwise, pertaining to any harm their vaccines may cause, you accept the following;
1. You, confirm, and acknowledge, that the vaccine has gone through the normal rigorous scientific and peer reviewed vaccine development process, and, is absolutely safe, and, that I will suffer no harm.
2. If, as a result of the getting the vaccine, I am harmed, and/or develop any known, or unknown, side effects, up to and including death, you personally accept total responsibility and full financial and legal, (civil and criminal), liability against yourself, your heirs, assigns, and successors, and as acting under the authority granted by the corporation, binding the Corporation's full financial and legal, (civil and criminal), liability to the corporation, its heirs, assigns, and successors.
3. Following acceptance of these conditions, the offer must be signed first by yourself, (printed full legal name, then your legal signature), showing having been granted authorization by the corporation, to encourage myself to get the vaccine, along with your job title, as a representative of the corporation, accepting full legal and financial responsibility, as well of that of the corporation, [as stated in number 2 above], for any and all vaccine related injuries occurring to myself, up to and including death.
4. In the event that I should have to decline the offer of vaccination, (notification of which shall be given within a reasonable amount of time of the signing of this document), [for reasons, possibly as, a finding of information unsatisfactory, or the lack thereof, or insufficient, or its inadequacy, or by any health dangers expressed], by withholding my consent, this contract shall be binding confirmation upon you, and the corporation, that this action shall not compromise myself, in any way, my job position, title, promotion possibilities, nor any other corporate benefit available, and that I will not suffer any retaliations, prejudice, persecution, or any type of discrimination as a result.
I look forward to getting full disclosure related to this recent change to my employment contract.
Thank you so much!
