Ontario’s non-medical immunization exemption form must be signed and sworn or affirmed before a Commissioner for Taking Affidavits. Bring it to any Canada Notary office and we’ll commission it for you.
The Statement of Conscience or Religious Belief is the Ontario form used to request a non-medical exemption under the Immunization of School Pupils Act. Child care settings use the same statement under the Child Care and Early Years Act.
For school exemptions, Ontario requires you to contact your local public health unit and complete a vaccine education session first. You’ll receive a Vaccine Education Certificate, and then the Statement is commissioned and submitted with it.
Get the current version from Ontario’s Central Forms Repository. Choose the version that applies to you.
Download the FormFor school exemptions, complete the vaccine education session through your local public health unit and get your certificate.
Complete the form but leave the signature blank.
Sign in front of our commissioner. Keep copies, then submit the originals as your public health unit or child care operator directs.
Either. You can choose to swear an oath or make a solemn affirmation.
No. We only commission the document. For questions about immunization, please speak to your public health unit or health care provider.
For school, submit it to your local public health unit. For licensed child care, give it to the child care operator.
Ontario allows remote commissioning by live video. Contact us to set up a video appointment.
This page is general information, not legal advice. Canada Notary is not affiliated with the Government of Canada or the Government of Ontario. Requirements change, so always use the latest version of the form from the official source and confirm with your local public health unit. Last reviewed October 2026.
Walk in or book at any of our Ontario offices. Bring the form unsigned and your photo ID, and we’ll take care of the rest. See our fee calculator for pricing.
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