As a parent or guardian, if your child or ward does not have an immunization record and you do not want your kids to be vaccinated based on your religious doctrines or conscience, you have the choice of exempting your child from immunization by completing and notarizing the statement of conscience and religious belief form (4897-64E) for your child and ward respectively.
What is a Statement of Conscience or Religious Belief?
A Statement of Conscience or Religious Belief form (4897-64E) when completed exempts a child who is in elementary or high school from immunization against the diseases designated under the Immunization of School Pupils Act.
Download the 4897-64E form here
What are the Designated Diseases Under the Immunization of School Pupils Act (“ISPA”)?
As a parent or guardian, you are required to immunize your child or ward against the following diseases:
- Diphtheria
- Tetanus
- Poliomyelitis
- Measles
- Mumps
- Rubella
- Pertussis
- Meningococcal
- Varicella (Chicken Pox)
For more information about immunization requirements for school attendance click here.
For more information on immunizing your children, please click here.
Why Do You Need a Notarized Statement of Conscience or Religious Belief affidavit?
Ontario’s Immunization of School Pupils Act (“ISPA”) requires that children and adolescents attending elementary or high school show proof of immunization against the ISPA’s designated diseases unless they have a valid exemption. To receive a valid exemption for non-medical reasons, parents must complete the Statement of Conscience or Religious Belief form that is sworn or affirmed before a notary public.
In addition, under the ISPA, the Medical Officer of Health may suspend your child or ward for failure to immunize except if he/she has been exempted.
What is the Information to be Completed on a Statement of Conscience or Religious Belief form?
As an applicant, you must complete the following information and get it certified by a notary public or designated person that can administer oath:
- Pupil’s name (first and last name)
- Home Address
- Date of birth
- Name of the School
- Grade or Class
What Do You Do After Notarizing the Statement of Conscience or Religious Belief form?
Upon completion and notarization of the Statement of Conscience or Religious Belief affidavit, you must submit the completed and notarized copy to the local public health unit, together with a certificate of completion proving that you attended the education session hosted by the local public health unit.
Is the Exemption From Immunization Absolute?
If there is an outbreak or threatened outbreak of any vaccine-preventable disease, the medical officer can exclude any student who is not immunized from the school, notwithstanding legal exemption. This means that your unimmunized child or ward will not be able to attend school until the outbreak is over.
How can All-Canada Notary Help You?
All-Canada Notary can help you notarize your 4897-64E form. Notaries can in-person and virtually notarize your sworn statements; and All-Canada Notary operates physical and virtual notary services, so you may not need to undergo the rigors of physical notarization. Hence, upon the completion and signing of the form, you can book an appointment online to notarize the statement of conscience and religious belief form for your child or ward.
