Free Ontario Statement of Conscience or Religious Belief Template
A formal sworn document used to declare a sincere objection to a requirement based on conscience or religious belief. Most commonly used for school vaccine exemptions in Ontario. This template includes the mandatory legal phrasing and a section for a Commissioner for Oaths or Notary Public to witness the signature.
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Contents
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What is a Statement of Conscience or Religious Belief in Ontario?
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When Do You Need a Statement of Conscience or Religious Belief?
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Completing Your Statement of Conscience or Religious Belief
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Commissioning Your Statement of Conscience or Religious Belief
What is a Statement of Conscience or Religious Belief in Ontario?
A Statement of Conscience or Religious Belief is used to request that a child be exempt from vaccination requirements in Ontario. This form requests a non-medical exemption for immunization against ISPA’s designated diseases. It is required under Ontario’s Immunization of School Pupils Act (ISPA), and a child’s parent or legal guardian must complete the form.
You must swear or affirm that the contents of your form are true, and sign it in front of an authorized official, like a notary public or commissioner of oaths. You can meet with a notary online and have your form commissioned in 7 minutes!
This document is sometimes referred to as a Children’s Vaccine Exemption Letter or a Children’s Vaccine Exemption Affidavit.
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When Do You Need a Statement of Conscience or Religious Belief?
You need this statement to request that your minor child be exempt from required vaccinations for non-medical reasons. These can include religious beliefs or personal conscience.
Children and adolescents in primary or secondary school, ages 4 to 17, must be appropriately vaccinated by law in Ontario. If you’d like to request that they aren’t immunized against the following diseases, you’ll need to complete a statement:
- Meningitis (meningococcal disease)
- Diphtheria
- Poliomyelitis
- Measles
- Mumps
- Rubella
- Whooping cough (pertussis)
- Chickenpox (varicella) – required for children born in 2010 or later
- Tetanus
Note: If you need to request a medical exemption, you’ll want to complete a Statement of Medical Exemption instead.
Completing Your Statement of Conscience or Religious Belief
To complete your Statement of Conscience or Religious Belief, you’ll need to provide a few details about your child or adolescent, including:
- Their first and last name
- Their home address
- Their date of birth
- The name of their School
- Their grade
- The immunization(s) you would like them to be exempt from
To learn about all the steps required to request a vaccine exemption for your child in Ontario, see our vaccine exemption guide.
Commissioning Your Statement of Conscience or Religious Belief
For your form to be valid, it must be commissioned by an authorized official, such as a notary. You can meet with a notary online from anywhere and have your form commissioned in less time than a coffee break.
Here’s what typically takes place during a commissioning appointment:
- An authorized official confirms your identity by checking your government-issued ID.
- They’ll ensure you understand what you’re signing.
- You’ll be asked to swear or affirm that the details in your document are accurate.
- The notary ensures you understand the document''s contents and that you’re signing voluntarily.
- You’ll sign and date the document as the notary witnesses your signature.
- The notary will sign the document too, and apply their official stamp or seal to complete the process.
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Statement of Conscience or Religious Belief
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