Freedom Advocate Explains How To Say No If COVID-19 Vaccination Becomes Mandatory


Declaration of Liability

The bearer of this instrument being a human man or woman retains the right of informed consent, free and unrestricted travel, and free and unrestricted association.


Address: ____________________________________________________________________



Heretofore the bearer of this instrument has assumed responsibility for medical decisions and the consequence thereof including:

Insurance, co-pays, medicines, supplements, appliances, travel and related items concerning health and health maintenance and responsibilities thereof.

Notification of Liability: YOU ARE HEREBY NOTIFIED

In view of, and because of, but not limited to, restrictions, limitations or absence of informed consent or, free and unrestricted travel or free and unrestricted association causing liabilities and costs incurred by mandates, orders or policies by governments, institutions, businesses, or entities, the person or persons carrying out such orders, mandates or policies on behalf of the aforementioned governments, institutions, businesses, or entities that have restricted, limited liability or are immune to liability causing harm by restricting in any manner, informed consent, free and unrestricted travel or free unrestricted association to the above named, by implementing or enforcing such actions are agreeing to be personally liable for all harms and obligations incurred to the above named in lieu of the government, institutions businesses, or entities with restricted or, limited liability or are immune to liability by implementation or enforcement. And shall be personally liable and assume all costs, obligations, fines, penalties and damages resulting from harms or liabilities of such implementation or enforcement.

Statement of Medical Liability:

I swear or affirm that I know and am familiar with the ingredients and components of the medication , drug or prescription ascribed to the above named and I have agreed to become directly liable for harm, liabilities or side effects resulting from the administering of this drug, prescription or medication.


Name:_____________________________ Occupation:____________________________________

Address:______________________________________City:_________State:______ Zip:________

Email:________________________________________ Phone:_____________________________

Company or Entity You Represent:______________________________________________________