PCR Testing not accurate


Herein the terms “administration” and “administrators” refers to all parties providing and/or “mandating” testing services and products including test Manufacturers, Marketers, Distributors, Hospitals, Clinics, Physicians, Nurses, Government Agents and Agencies, Healthcare Providers, Elected Officials, Enforcement Persons, Pharmacists, Agencies and Programs, Businesses and all other parties bringing “mandated” tests to application or to market in any way for COVID-19.

This is agreement between the parties identified herein who on one hand, will receive the relevant test (PCR test or otherwise) or be affected by the consequences of the test including the recipient party/ies, their guardians, representatives, and all persons of common interests and, on the other hand, the administrators and providers of the test/s in all the various capacities. Those parties shall be identified at the end of this document.

Individual intended for Testing:____________________________________
Circle one: Adult Minor

Parents’ or Guardian’s Names and/or Head of Household: __________________________________________________________________________

Children’s names (all family members):___________________________________________




Other contacts if available:_____________________________________________________

Name of test to be provided____________________________________________________

Where test is a RT-PCR test, number of cycles:____________________________________

As administrator of this test, I hereby agree to and with the following representations, stipulations, terms, declarations and positions:

1. I am aware and understand that the relevant test/s referred to above to be performed which is/are not a perfect or a fully proven method of determining whether a person is actually infectious or has COVID-19.

2. I am aware and understand that test/s referred to above are not 100% accurate and that they release both false positive and false negative results and that higher amplification cycles result in the greater likelihood of a positive test.

3. I am aware and understand that the test/s themselves, which can involve the insertion of foreign material deeply into the nasal passages, can cause death or injury and disease, which seriously and negatively affects the lives of tested individuals, their families and their communities.

4. I am aware and understand that tests, when causing disease and injury, can cause major costs to individuals, families and communities, which costs are solely the responsibility and liability of the causing agents which are the administrators and providers of a harming or ineffective test.

5. I am aware and understand that no one may be forced, coerced or compelled to accept medical treatment, testing and examination or foreign substances inserted into their bodies without full voluntary consent under full disclosure and that administering a treatment or examination, harmful or otherwise, without consent of all affected parties is unlawful and unethical.

6. I understand that individuals have different physiologies and that a test which requires the insertion of testing equipment into the nasal passage or other method of testing that may be harmless to one individual may be quite harmful to another individual.

7. I am aware and understand that, prior to administration of any test, administrators of the test must and shall disclose to all interested parties all known and presumed risks, hazards, harm and failures of the test (including any consequences of rupture of blood vessels or other tissues, any possible contamination from the test materials and any risks, however, small of temporary or permanent introduction of nanoparticles or other materials which may cause harm or even potential changes to a recipient’s DNA).

8. I am aware and understand that, prior to the administration of any test, administrators of the test must and shall disclose to all interested parties all known and presumed intended use of human tissues, DNA or other material collected during the test and retention of such material, so that the recipients of test can make fully informed decisions with regard to accepting the results of the test or examination.

9. I am aware and understand that administration of tests and examinations without full disclosure of the above and the full voluntary consent of all interested parties involves imposing risk and hazard in a way which represents criminal violation, malpractice, and major liability of the administrators of the test to the recipient party/ies should any negative consequences arise.

10. I am aware and understand that any person who attempts to enforce a “mandate” in forcing or coercing examination or testing or any other medical treatment upon any unwilling or uninformed party, whether or not that “mandate” is provided in law, codes, directives or regulations, is personally fully liable for any and all harm, loss, damage, and/or negative consequences of the testing upon the recipient party (including, for the avoidance of doubt, any harm, liability or consequence arising from any change, however small, to the recipient party’s long term health and DNA) and all other interested parties. That liability extends to all administrators of that “mandate”, all legislators who were involved in the creation of that “mandate”, all companies and individuals who promoted that “mandate” through lobbying or other political action, and all parties who participate in the enforcement of the “mandate.

11. I understand that, as an administrator or provider of any “mandated” test or examination I am assuming all liability, obligation and responsibility for any and all negative and/or unintended consequences of the administration of the examination or test and that I must “make whole” the recipients of the test or examination, their guardians, families and community for any and all financial and personal harm, damage and losses caused by the test or examination and any and all harm that may be reasonably attributed to the test or examination, including any consequential effects from the test or examination (which could include both health, mental and financial consequences as a consequence of any administration of the test or examination, the use of DNA or other material obtained from the test or examination and any tainting of the recipient’s DNA arising in consequence of the test or examination). I understand that this is necessary because laws do not adequately protect test and examination recipients and, in fact, put the public at risk of uninsured harm from these tests and examinations.

12. I am aware and understand that I must disclose all risks of testing or examination prior to administration of the test or examination and, because such medical procedures do pose risks, I must allow the recipients, guardians and families to refuse the test or examination at their sole discretion, and that disclosure of hazards and risks does not absolve me from any responsibility, liability or accountability for negative consequences of the test or examination I administer.

13. If a person suffers any disease or injury at any time after the testing or examination and not before testing or examination, and that disease or injury cannot be affirmatively attributed to any particular cause other than the test or examination, then I agree that it is reasonable to presume that the injury or disease was or may have been caused by the test or examination, and I will so presume and accept that theory in the absence of compelling evidence to the contrary.

14. If the recipients, guardians, family members and interested parties of the tested or examined party should, after the test or examination, submit claims for harm, loss, damages, injuries or disease that they reasonably suspect to be caused fully or partially by the test or examination, then the claims must and shall be paid and delivered by the administrators of the test or examination to the claimant/s without challenge within 30 days from submission of each claim, and any challenge to the claim/s must be made through formal written process and/or non-binding arbitration. Refusal or obstruction of service of claim shall not reduce obligations and shall be cause for escalated claim.

15. I am aware and understand that all administrators of tests and examinations are responsible for any emotional distress caused by their test or examination, and are liable for compensation for such emotional distress caused to the victim/s.

16. Administrators of tests or examinations hereby agree that they will allow and facilitate recording, videotaping, documentation and investigation of all services, processes and facilities associated with the administration of the test or examination, and that administrators of tests or examinations will not refuse or obstruct that information gathering for any reasons such as “privacy,” “security”, or “proprietary”.

17. I am aware and understand that any failure or refusal to sign this agreement causes suspicion of intention to do harm to the recipient party and others and to avoid responsibility for potential harm that may be caused by the test and/or examination, and I am aware and understand that failure or refusal of signature of this agreement by any administrator of such test and/or examination is cause for rightful refusal of the test or examination by the intended recipient with law, code, regulations, directives, contracts and “mandates” notwithstanding.

18. Any threat of consequence for refusal of testing and/or examination/s, such as removal from school, quarantine, “child endangerment,” removal from employment, removal from shops, restaurants and other business premises, criminal prosecution, “civil penalty” etc. is coercion, is offensive, inappropriate, unlawful, and/or violates parental and human rights. There is no valid law that would rightfully grant authority over any individual to determine medical examination or treatment for any other party who is in possession of his or her faculties. Refusal of testing and/or examination does not in any way imply poor judgment, diminished capacities, or social irresponsibility because there are extensive public records showing harm, injury and death caused by testing and/or examination and which also show that the test referred to above does not, in fact, accurately diagnose the actual illness of the individual with COVID-19.

19. I am / am not (circle one) claiming that I personally have the right and authority to force medical treatment and testing and/or examination upon the party (above) whom I intend for testing and/or examination without his/her consent. If I claim that authority, then I will provide all legal and official reference that bestows that authority upon me specifically against the intended recipient of the test and/or examination. I understand that I must provide evidence of authority to the satisfaction of all interested parties before the person intended for testing and/or examination may be tested or examined because the interested parties presume that no such authority exists nor can exist, and, in many cases, the harm caused by tests cannot be reversed.

20. I understand and agree that the person intended for testing and/or examination is not responsible to gather signatures on this form. The parties intending to test and/or examine must acquire and share this form, sign it, and deliver it to any party intended for test or examination upon request. At such time as the duly signed forms are delivered to the person intended for testing and/or examination, those agreement forms will be signed by the person intended for testing and/or examination or by his/her guardian, and one copy will be returned to each administrator of the test and/or examination/s. If one of the requested administrators above fails to sign and return the form, all agreements are void and testing and/or examination is rightfully refused.

21. Refusal to sign this form is indication of deceit, bad faith and hypocrisy on the part of a test or examination administrator who may recommend tests and/or examinations as “safe” and the most appropriate test for the determination of whether the recipient is actually infected with and ill from COVID-19, but, at the same time, deny responsibility for the hazards. If tests and/or examinations are “safe” and “appropriate” then refusal or hesitation to sign this form is firm indication of misrepresentation with the assertion of “safety” and/or “appropriate for the determination of the actual disease called COVID-19”.

If this form is refused or not signed by any test or examination administrators listed above, then refusal of such test or examination is rightful and refusal must be presumed and honored. Testing and/or examination itself does pose risks, therefore administration of test and/or examination without signature on this agreement by all parties called for herein and/or without fully informed consent by all interested parties constitutes criminal assault, malpractice, intentional harm, and violation of rights against the recipient parties and all other parties of common interest by the administrators and providers of the test or examination whether any harm is caused or not by the test or examination, therefore, without fully informed consent by all interested parties, major obligations and liabilities arise from non-consensual testing or examination whether or not the test or examination causes physical injury, disease or other damage.

I agree that refusal to sign this form constitutes admission and warning to the prospective recipient of testing or examination that such test or examination may cause harm and should be avoided in order to protect the health and safety of those receiving treatment.

Refusal by any administrator of a test or examination to sign this form is grounds for the intended recipient of the test or examination or his or her guardians to refuse testing or examination pending the necessary safeguards and insurance provided by the responsible party/ies.

This agreement is separate and distinct from any benefit/s, or “necessities” that may be attributed to testing or examinations. The public may only be protected when to do so does not violate the rights of an individual.

Any testing or examination procedure that is not shown, by rigorous trials, certifications, and general administration to be free of risk (however small), and which is accepted as such unanimously by the scientific and medical communities, or which is not being administered and “mandated” by a licensed physician to a consenting patient may not be administered lawfully or without major liability and penalty for administering medicine without a license and/or without the consent of the patient. Non-consensual testing and examination violates the Constitution of Australia, the Biosecurity Act 2015, Victoria’s Public Health and Wellbeing Act 2008, medical codes of ethics, and a number of international treaties and laws.

NOTICE: A separate agreement must be signed for each individual intended to be tested or examined and for each separate test or examination even if separate tests or examinations are “combined” in one treatment.

By signing this form, I agree to accept full liability and will be personally responsible for all harm, hazard, damage and loss caused by the test and/or the examination that I am administering, and I hereby waive all immunities granted by any legal instrument or process.

I understand that the intended recipient accepts testing and/or examination on the condition that it is proven safe and effective to all reasonable expectation, that the DNA and other genetic material obtained in consequence of that testing and examination shall be used solely for the purpose of the testing or examination and, following acceptance of the results of such testing or examination by the recipient, shall be immediately destroyed thereafter and insurance is provided at my expense to cover all possible future claims of damage.






Signatures, identification and contacts for responsible parties (test and/or examination administrators):

Authorized Officer of Test Manufacturer,


Title :________________________________________________________________

Address: ________________________________________________________________________

Phone: _________________________________________________________________

Driver’s license number: _________________________________________________

Alternate contacts and identification: ________________________________________

SIGNATURE ___________________________________________________________

Authorized Officer of the Organization Administering the Test or Examination,

Name: ________________________________________________________________

Title: ________________________________________________________________

Address: ________________________________________________________________

Phone: ________________________________________________________________

Driver’s licence number: __________________________________________________

Alternate contacts and identification: _________________________________________

SIGNATURE ____________________________________________________________

Authorized Officer of the Organization Administering Test or Examination,

Name: _________________________________________________________________

Title: _________________________________________________________________

Address: _________________________________________________________________

Phone: _________________________________________________________________

Driver’s licence number: ___________________________________________________

Alternate contacts and identification: __________________________________________

SIGNATURE _______________________________________________________________

Individual Administering the Test and/or Examination to the Recipients (Nurse, Healthcare Provider or

Name: _________________________________________________________________

Title: _________________________________________________________________

Address: _________________________________________________________________

Phone: _________________________________________________________________

Driver’s licence number: ___________________________________________________

Alternate contacts and identification: __________________________________________

SIGNATURE _______________________________________________________________

Elected officials, bureaucrats and enforcement personnel supporting “mandate” of medical treatment and/or examination or testing (attach additional sheets as necessary):

Name: _________________________________________________________________

Title: _________________________________________________________________

Address: _________________________________________________________________

Phone: _________________________________________________________________

Driver’s licence number: ___________________________________________________

Alternate contacts and identification: __________________________________________

SIGNATURE _______________________________________________________________

Authorized Officer responsible for distributing the Test to healthcare facilities and providers:

Name: _______________________________________________________________

Print Name: _______________________________________________________________

Direct Contact information:



Date: _________________________________________________________________

SIGNATURE _______________________________________________________________

When the party intended for testing and/or examination is able to confirm and assure the safety and effectiveness of the offered test and/or examination for the purposes of determining whether the recipient does indeed have the disease COVID-19, receives insurance or bonding for all possible harm and damage, receives a complete description of the nature of the test and/or examination together with a list of all ingredients and contaminants of the relevant test, and receives full identification and contacts of all responsible parties (above), the party intended for testing and/or examination will determine whether it is appropriate, prudent, safe or necessary to provide consent to be tested and/or examined.

IF THE AGREEMENT ABOVE IS NOT SIGNED, the administrator offering or “mandating” a test or examination is required to sign the following statement exclusive of all statements above:

I decline to sign the above agreement because I am unwilling to accept personal liability for the harm, damage and/or loss that my test and/or examination may cause.

Print name ____________________________________________________________

Title ____________________________________________________________

Address ____________________________________________________________

Phone contact ____________________________________________________________

Driver’s Licence Number ___________________________________________________

Date: ____________________________________________________________

SIGNATURE ____________________________________________________________