Vaccine Risk Legal Disclosure

vaccination disclosureThis risk disclosure agreement is for parents who are vaccinating a child.

Vaccination is important for your child’s health and involves certain risks to his/her long-term health. You are choosing to vaccinate your child. Your signature is required that you accept these risks, and you agree not to bring lawsuit against your doctor, health insurance provider, or state government in the event your child comes down with a serious illness later in life.

I understand my child, by receiving the Varicella (“chickenpox”) vaccination, has a 15% higher lifetime risk of glioma brain tumor.

Sign here: ____________________________________  Date: _________________

I understand my child, by receiving the Varicella (“chickenpox”) vaccination, has an 84% higher lifetime risk of allergic conjunctivitis.

Sign here: ____________________________________  Date: _________________

I understand my child, by receiving the Varicella (“chickenpox”) vaccination, has an 88% higher lifetime risk of asthma.

Sign here: ____________________________________  Date: _________________

I understand chronic asthma increases risk of lung cancer by 82%.

Sign here: ____________________________________  Date: _________________

I understand my child, by receiving the MMR vaccination, has up to a 30% higher risk of Hodgkin’s lymphoma.

Sign here: ____________________________________  Date: _________________

I understand my child, by receiving the DTaP vaccination, if it blocks my child from a persistent cough in his/her first year, has a 23% higher risk of childhood leukemia.

Sign here: ____________________________________  Date: _________________

I understand leukemia is the most common cancer in children and teens, accounting for almost 1 out of 3 cancers.

Sign here: ____________________________________  Date: _________________

Vaccinations are very important and prevent illnesses which can be painful, such as varicella (“chickenpox”), epidemic parotitis {“mumps”), and pertussis (“whooping cough”). With vaccination, your child’s risk of glioma brain tumor, asthma, lung cancer, allergic conjunctivitis, Hodgkin’s lymphoma, and childhood leukemia will be increased. The Centers for Disease Control recommends you keep your child on his/her vaccination schedule.


Indicates chickenpox reduces glioma brain tumor risk by 15%:

Canniff J, et al “Cytotoxicity of glioblastoma cells mediated ex vivo by varicella-zoster virus-specific T cells” J Neurovirol. 2011 Oct;17(5):448-54. doi: 10.1007/s13365-011-0048-z

Shows chickenpox protects against glioma brain tumors:

Wrensch M, et al “History of chickenpox and shingles and prevalence of antibodies to varicella-zoster virus and three other herpesviruses among adults with glioma and controls.” Am J Epidemiol. 2005 May 15;161(10):929-38 Pubmed link

Shows the varicella vaccine deprives benefits that wild-type offers, thereby increasing allergic rhinoconjunctivitis risk by 84%, and asthma risk by 88%:

Silverberg J, et al “Chickenpox in childhood is associated with decreased atopic disorders, IgE, allergic sensitization, and leukocyte subsets” Pediatr Allergy Immunol. 2012 Feb;23(1):50-8. doi:10.1111/j.1399-3038.2011.01224.x

Shows asthma increases risk of lung cancer by 85%:

Mayne S, et al “Previous lung disease and risk of lung cancer among men and women nonsmokers.” Am J Epidemiol. 1999 Jan 1;149(1):13-20. weblink

Shows women who had childhood measles had 30% less risk of  Hodgkin’s lymphoma:

Glaser S, et al “Exposure to childhood infections and risk of Epstein-Barr virus–defined Hodgkin’s lymphoma in women” Int J Cancer. 2005 Jul 1;115(4):599-605. Pubmed link.

Shows catching a persistent cough in first year of life reduces childhood leukemia risk by 23%:

Urayama K, et al “Early life exposure to infections and risk of childhood acute lymphoblastic leukemia”  Int J Cancer. 2011 Apr 1; 128(7): 1632–1643. doi:  10.1002/ijc.25752

Key statistics for childhood leukemia:

Meta Analysis

In fact, the evidence shows such a vaccination disclosure form should be provided to parents getting children vaccinated. There are serious risks to thinking we can “skip” childhood viruses. Risks like brain cancer, asthma, lung cancer, leukemia and Hodgkin’s lymphoma.

Unfortunately, the “vaccination autism argument” had done immense public damage because it has fueled the “Salem Witch Hunt” of our times; today’s witches being anti-vaccination parents.

The Anti-Vax Witch Hunt has distracted us in two fatal ways:

  1. We are missing the obvious: our autism spike is being driven by radiation exposure to reproductive cells, covered at
  2. Even though vaccinations are not driving autism, they are driving brain cancer, asthma, lung cancer, leukemia and Hodgkin’s lymphoma

Religious exemption to vaccination should be upheld at the least. I am the father of two, and my religion is preventing cancer and disease for my children. That a government has the power to force my kids into higher risk of cancer to prevent chickenpox is, frankly, infuriating.

The American Brain Tumor Association lists gliomas as accounting for 30% of all brain cancer. That’s approximately 21,000 Americans per year. Wild chickenpox would prevent approximately 15% of these cases (or growth by an equivalent number), which is 3,150. Let’s be conservative and reduce the number to 3,000. The bottom line is that the chicken pox vaccine is causing about 3,000 cases a year of highly malignant brain cancer.

The increase in death, as well as healthcare cost, from picking the short-term approach of vaccination is shocking. Benelles philosophy, similar to long-term financial investing, is short-term pain for long-term gain. The fact that cancer rates increase dramatically for children who “skip” common childhood diseases via vaccination is a strong indicator that our benelles need to “go to school” by catching viruses, just as our children go to school to learn arithmetic.

Benelles calls upon a coalition of organic industries and concerned parents to bring a lawsuit against our government requiring parents to accept the long-term risks of vaccinating their children. This should be achievable as it would protect doctors, insurance companies, and the government.

The American middle class will be better off if we stop the  current anti-vaccination witch hunt and allow parents to choose an evidence-based health approach if they wish.