Statement of Conscience or Religious Belief (Vaccine Exemption Request)

Those who want to receive a vaccine exemption for non-medical reasons for their children and individuals employed in a child care setting must complete a form called, Statement of Conscience or Religious Belief. There are three versions of this form (two for children, and one for individual child care workers):

Statement of Conscience or Religious Belief for Child (Child Care and Early Years Act, 2014)

• To exempt children too young to go to primary school from immunization.

Statement of Conscience or Religious Belief (Immunization of School Pupils Act)

• To exempt children and adolescents attending primary or secondary school from vaccination.

Statement of Conscience or Religious Belief for Individuals (Child Care and Early Years Act, 2014)

• To exempt individuals employed at child care centres or home child care agencies from immunization.

To exempt their child from vaccination requirements, a parent/guardian must complete a Statement of Conscience or Religious Belief for Child or the Pupils Acts version. These forms are sometimes called the “children’s vaccine exemption letters” or affidavits. All the above forms have an affidavit portion, which must be witnessed by a notary public or commissioner for taking affidavits.