Vaccine consent form

[Soroush Ebrahimi]

Dear colleagues
I came across this form yesterday.
It may be useful to see if any allopathic practitioner would sign it.
Soroush
Vaccine Name:
VACCINATION CONSENT FORM
I hereby give my consent to my child …………………………. being vaccinated with the above vaccine subject to the following conditions:
1. That the booklet which has been supplied is fully accurate both as to the safety and the efficacy of the above-mentioned vaccine.
2. That the person (doctor or nurse) performing the vaccination, the Health Authority, the manufacturers of the above mentioned vaccine and the Department of Health will accept full joint and several responsibility for any injury caused to my child as a result of the above mentioned vaccine being administered.
3. That in the event of any such injury being caused, my child will receive full compensation, assessed in accordance with the normal principles of English Tort Law.
If these conditions are not acceptable, the vaccination should not take place.
For the vaccinating Agency
……………………. …………………….

Parent’s Name (Name in Capitals)

Date: Date:
The person vaccinating
……………………. …………………….

Parent’s Name (Name in Capitals)

Date: Date: