Statement of Conscience or Religious Belief (Form 4897-64E)
Your completed Statement of Conscience or Religious Belief needs to be commissioned in order to receive a non-medical exemption for your child from vaccine / immunization requirements. Dotted Line Notary can help you commission your Statement of Conscience or Religious Belief.
What is a Statement of Conscience or Religious Belief?
Ontario's Immunization of School Pupils Act (“ISPA”) requires that children and adolescents attending primary or secondary school show proof of immunization against the ISPA’s designated diseases unless they have a valid exemption.
In order to receive a valid exemption for non-medical reasons, parents must:
Complete the immunization education session required by the ISPA; and
Complete the Statement of Conscience or Religious Belief form that is signed, and sworn or affirmed before a notary public.
Parents must submit the above mentioned documents to the medical officer of health of their local public health unit.
To find the local public health unit in your area, click here.
Information about vaccines and Ontario’s publicly funded immunization program is available here.
To download the Statement of Conscience or Religious Belief form, click here.
To review the Ontario ISPA, click here.