Freedom of Choice ImageWell, I’ve had some trouble finding the original source of the letter and statutory declaration mentioned in the previous post, Administering Vaccines Against a Person’s Wishes is Illegal but I finally managed to track it down and lo and behold, It was on Tasha David’s website, Poly mum of Eight

I really should have known. Tasha is the President of the Australian Vaccination Network and is a widow raising 8 children – 6 of whom has various levels of disability due to vaccine reactions. Only her youngest 2 – who are completely unvaccinated – are completely healthy.

Despite this and despite the fact that her doctor has attested to the fact that vaccines were the cause of her children’s problems, Tasha will lose out on tens of thousands of dollars under the current legislative changes under the immoral, illegal and discriminatory No Jab No Pay legislation.

To add insult to injury, because she lives in Victoria, she will also not be able to get childcare for her younger, unvaccinated children due to the Victorian government’s No Jab No Play legislation which bars healthy unvaccinated children from mixing with their fully-vaccinated compatriots. Find the logic there (hint from me: there isn’t any!)

Being the amazing activist that she is, Tasha has sought legal advice and the following documents were produced with the assistance of a solicitor with expertise in these issues. They should be used as is – without any changes – for the best possible effect.

I hope that all of you who are going to be affected will go to your doctors or the doctor at your local council clinic to get them to attest to the fact that they will not vaccinate your children against your wishes. If enough of us do this, the government will be backed into a corner – well and truly!

Below is the form which has been designed for this purpose for parents in this situation:


I, …………………………………………….…..
name and title of Immunisation Provider

confirm that ……………………………..………
name of parent/s

has/have presented their child ..…………………..………………..………….…..
name of child

on this date………….… for the following vaccinations: ………..…. ……..……

I acknowledge that the consent provided by …… ……………………………….. name of parent/s is not voluntary consent.

Given the absence of voluntary consent, I am/am not willing to proceed with the vaccination of …………………………………………..
name of child

Signed by: …………………………………………………
name and title of provider

In the presence of : …………………………………………………
signature of witness

name of witness

Date: ………………………………………….


The Immunisation Provider (IP), upon being presented with the form, will either:

(1) complete the form in such a way as to indicate that the IP is not willing to proceed with the vaccination, and will then sign the form, or

(2) decline to sign the form, in which case the parent may sign a Statutory Declaration stating that the parent asked the IP to sign the form and the IP refused. This will have the same effect as (1).

The wording of the Statutory Declaration should be as follows:


I, ……………………………….. confirm that I has/have presented my child …..………………..
name of parent/s name of child

to ……………………………..…………………
name and title of Immunisation Provider

on this date………… for the following vaccinations: ……………….. ………………

I informed the Immunisation Provider that my consent is not voluntary consent.

I presented the attached form and requested the Immunisation Provider to complete and sign the form. The Immunisation Provider then refused to sign the form.

Signed by: …………………………………………………
name of parent/s

In the presence of : …………………………………………………
signature of witness

name of witness


The parent may then lodge a complaint through Centrelink on the grounds that they are being disadvantaged through no fault of their own.

If the government is going to tell us they will disadvantage us for making legal, informed health choices for our children, then they must be made to take responsibility for the outcomes of this coercion.

In the Australian Immunisation Handbook, under Informed Consent for Vaccination, it states:

2.1.3 Valid consent
Valid consent can be defined as the voluntary agreement by an individual to a proposed procedure, given after sufficient, appropriate and reliable information about the procedure, including the potential risks and benefits, has been conveyed to that individual.2-6 As part of the consent procedure, persons to be vaccinated and/or their parents/carers should be given sufficient information (preferably written) on the risks and benefits of each vaccine, including what adverse events are possible, how common they are and what they should do about them7 (the table inside the front cover of this Handbook, Side effects following immunisation for vaccines used in the National Immunisation Program (NIP) schedule, can be used for this purpose).

For consent to be legally valid, the following elements must be present:6,8

It must be given by a person with legal capacity, and of sufficient intellectual capacity to understand the implications of being vaccinated.

It must be given voluntarily in the absence of undue pressure, coercion or manipulation. (emphasis added)

It must cover the specific procedure that is to be performed.
It can only be given after the potential risks and benefits of the relevant vaccine, risks of not having it and any alternative options have been explained to the individual.
The individual must have sufficient opportunity to seek further details or explanations about the vaccine(s) and/or its administration. The information must be provided in a language or by other means the individual can understand. Where appropriate, an interpreter and/or cultural support person should be involved.

Consent should be obtained before each vaccination, once it has been established that there are no medical condition(s) that contraindicate vaccination. Consent can be verbal or written. Immunisation providers should refer to their state or territory’s policies on obtaining written consent (refer to Appendix 1 Contact details for Australian, state and territory government health authorities and communicable disease control).

Consent on behalf of a child or adolescent
In general, a parent or legal guardian of a child has the authority to consent to vaccination of that child; however, it is important to check with your state or territory authority where any doubt exists.2,5 A child in this context is defined as being under the age of 18 years in Tasmania, Victoria and Western Australia; under the age of 14 years in New South Wales; and under the age of 16 years in the Australian Capital Territory, South Australia and the Northern Territory. Queensland follows common law principles.

For certain procedures, including vaccination, persons younger than the ages defined above may have sufficient maturity to understand the proposed procedure and the risks and benefits associated with it, and thus may have the capacity to consent under certain circumstances. Refer to the relevant state or territory immunisation service provider guidelines for more information.

Should a child or adolescent refuse a vaccination for which a parent/guardian has given consent, the child/adolescent’s wishes should be respected and the parent/guardian informed. 2

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  1. There are a few typo’s in the first form. But this sounds like a legally valid way of dealing with the issue. The government has made a law that conflicts with so many other laws, and makes so little sense, that they will get into trouble one way or another. Our politicians must have voted with their bank accounts to get this through, for no normal, intelligent person would do this.

  2. oh there is some spelling mistakes in the stat declaration!! can you please resend out so that everyone can be getting the same form signed! looks like some letters jumped out of place in the ‘given’ line! good luck

    On Tue, Jan 5, 2016 at 1:01 PM, nocompulsoryvaccination wrote:

    > peoplewhoknittoomuch posted: “Well, I’ve had some trouble finding the > original source of the letter and statutory declaration mentioned in the > previous post, Administering Vaccines Against a Person’s Wishes is > Illegal but I finally managed to track it down and lo and behold, It was > on”

    1. Thanks Melissa and Rixta – I think that must have happened after I copied and pasted. I thought I had checked the formatting but obviously, I missed something 🙂 If you see anything else, please let me know.

      1. Mine vaccinated without my consent when sick in hospital and now has Autism. I have no way of proving they vaccinated her though. As a Mum I know when my child changes suddenly.

  3. there has already been a few women who have had DOCS/DHS/FACS knock on their doors, some just with questions and harrassment others have had their children REMOVED – no contact ! and part of the wording by family services mentioned refusal of vaccinations for their children ! my only concern with this is that we are going to see more and more of this – especially if we fight back

    1. I understand your concern. My feeling is, however, that if we don’t fight back, we won’t need to wait for DOCS to come knocking – we might as well just hand our children over to them straight away.

    2. Your going to see more of this if you don’t claim your authority and act goddamn it..ask the doctors to take full LIABILTY for all harm…make the doctors download the full vaccine insert from online….get them to acknowledge the sometimes pages long list of possible side effects..ask them then if they accept for Personal liability……make it clear that you are are under treat and duress to sign…ask them if they will go ahead with the vaccine knowing that you are NOT CONSENTING…

    3. You’ve just scared the crap out of me with this, Persephone.
      Do you have more information?
      Does anyone else with a legal background have anything to add??

  4. I guess vaccination (at gun point) will be approaching in the future, as it has already happened in the US.

    If we don’t stand up and fight for our children, who will?

  5. Just for everyone’s information, C& K Childcare have stated through their CEO that they will NOT refuse admission to any Unvaccinated child.They have 126 Childcare centres throughout SE Qld.
    Brian and Susan Cook.

    1. nocompulsoryvaccinationYes, that’s right! And another large childcare provider, Gold Coast Childcare Centres, who have also announced publicly that they will welcome unvaccinated children. The support for discrimination is not community-wide. In fact, out of the more than 2,500 submission to the Senate Inquiry into No Jab, No Pay, only a few were supportive of the legislation – the vast majority opposed it including the RACGP, Julie Leask from the NCIRS, the Public Health Association and a lot of pro-vaccine doctors. Who was pushing this legislation then – if the medical experts didn’t support it? I think the answer can be found in the pharmaceutical interests who seem to own our government, lock, stock and barrel.

    2. Does anyone know of any Family Day Care/Childcare centres that will do the same in SE Victoria?

  6. C&K Chidcare CEO has stated they will not refuse entrance to any unvaccinated children. They have 126 Centres throughout SE Qld. Brian and Susan Cook.Coomera.Qld.

    Sent from my iPad


  7. Hi Admin,
    General Maddox from here.
    I and my colleagues from other sites have been following this issue closely. Here is one of my recent pieces that went viral…
    I’d like to do a new article highlighting what you’ve posted above with your permission.
    I will link back here of course. I think getting this out to as many people as possible is paramount!

  8. DOCHS came knocking and had what reason?

    The write yo in the heral sun makes out non compliant people are fanatics.
    Like Lindy Chamberlain you will feel society’s weath if you don’t and suffer agonies if you so.
    They know they have you by the neck.
    from what I understand the vaccines from 2 months to 15 years are to be done in one year INCLUDING 2-4 influenza which killed and retarded large numbers of children plus the cervical cancer vaccine which also killed in agony large numbers of teenage girls – yet, and I seriously question this – it’s still on the list.
    What the hell is really going on?

  9. Who had their children removed?
    On what grounds?
    We’re there other circumstances?
    That sounds awfully frightening?
    What if they chose not to have the family tax part A
    and then thats their next come back till we all serve
    on our knees?
    Sounds a lot like Egypt in bible times when the kids
    we’re thrown into the river at pharaohs whim because
    there were too many Israelites.
    I’ve read that affluent people aren’t worried about the
    financial threat. Will they remove all their children too?
    Are these parents fighting to get their children back?
    We’re they forcefully removed to be immunised, and then
    What are the real facts here. This is gestapo like, if it’s true.
    My eldest survived in intensive care by a thread after receiving
    2 tetanus injections by mistake.
    My third son was not expected to last the night after near dying as well.
    What are the options? Forced removal of parenting rights or forced removal
    of parenting at all???
    Who knows the real story here?

    1. I would like to ask all of you parents who are anti vaccine if you have been vaccinated yourselves as children and if you have had any adverse reactions? It seems to me that you are denying your children the health that you currently enjoy. What will you tell your children when as adults they travel overseas to countries where infectious diseases are prevalent, and they are exposed to these diseases without immunization. I have traveled to underdeveloped countries such as Cambodia whose parents would give their right arm to have free vaccinations for their children such as we have in Australia. Believe me their children are still dying from these diseases which were virtually eradicated in Australia, but which now are on the rise because parents do not vaccinate !

      1. Who says the vaccines of 40-50 years ago have the same components and we already know that previous generations had single does not 3 and 4 vaccines at a time, so its not comparing apples with apples.

      2. I was given some, and reacted so was not given further. That along with auto immune issues, make us NON Vaxers… not ANTI Vaxers. I’m not anti, totally ok with parents choosing to Vax their kids. But it should be the parents choice, not government. For us, there were too many risks involved in having our children vaccinated. I do not bully anyone about it or name call.

      3. Vaccines don’t work. Both my wife and I were vaccinated for measles, and still got measles. Vaccines often cause the same or worse symptoms than that of the disease they allegedly protect against. Why risk death by SIDS or a lifetime ailment such as autism, for no guaranteed benefit?

        If vaccines are so effective, why all the effort to silence debate and bully parents into vaccinating through financial pressure? Truth does not fear exposure, and real medicine doesn’t obtain patients through extortion.

  10. Hi there, I am not so worried about the ‘no jab no pay’ but the ‘no play’ is what affects my children the most. Does anyone know any kinders or childcare in Victoria (Preferably North region) that will accept un-vaccinated children?

    1. if you hold a health care card , by law any child care should accept your child.

      1. That is true, in Victoria HCC holders are able to enrol under the 16 week grace period.

  11. First of all thank you for posting these forms. I will be using these and cannot wait to see my GPs face when I present them.
    Secondly to Maree who posted that those of us who choose not to vaccinate are denying our children health. Well Maree, can I ask you, before you write in judgement, to actually do your due diligence and research the reasons we are not vaccinating our kids. Let’s see, in no particular order: 1. Most vaccines still contain over 49% of mercury, and so that combined with formaldehyde and aluminum create a synergistic effect 10,000 fold (If you are not following me Maree think it’s time to hit the books). The last time I check mercury was the second most poisonous compound next to plutonium…so why would I put that in my adult body never mind my child’s which has yet to develop a strong immune system. 2. “Orthodox” medicine has yet to produce ANY relevant, cohesive, extensive research into the benefits of the vaccines they claim to NOT have any effects on the onset of severe autoimmune disease and autism. So how do you expect an educated person to make an educated decision when we are not getting all of the facts. 3. Did you know Maree that prior to the vaccination on slot of “jabs” Australians are forced to undertake the prevalence of disease in Australia was virtually nil? It just so happens that many of the key members of the boards associated with making these decisions are also key members of drug companies.
    So Maree and anyone else that wishes to post ridiculous uneducated and uninformed comments about vaccinations-check your premise.

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