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Living > Public Health, Safety

Vaccination Exemption Forms

Elementary and Secondary Schools

The Immunization of School Pupils Act requires every Public Health unit to have either an updated and complete vaccination record or a legal exemption form on file for each child attending school.

If you choose to not have your child vaccinated (for medical, religious or philosophical reasons) you need to submit either a statement of medical exemption or statement of conscience or religious belief affidavit.

Statement of Medical Exemption

For your child to be exempt, you must complete and submit a statement of medical exemption. Speak with your physician to have this form completed.

You can also call the Vaccine Preventable Disease Program at 905-688-8248 or 1-888-505-6074 ext. 7425 to obtain this form and then bring it to your physician.

You may have your physician submit the medical exemption form to us (or you can submit to us) the original form via mail:

Niagara Region Public Health
Vaccine Preventable Disease Program
P.O. Box 1052, Station Main
Thorold, ON L2V OA2

Exemption for Religious or Conscience Beliefs

The following steps must be taken to ensure your child is exempt from the vaccination for conscience of religious reasons:

  1. Complete only the top section of the form:

  2. Have the exemption form signed and stamped by a commissioner of oaths or a notary public, or a justice of the peace.

    Getting the Statement of Conscience or Religious Belief Affidavit Signed

    • A Commissioner of Oath is available at Niagara Region Headquarters to sign these affidavits. Please call the Clerk's Office at 905-685-4225 ext. 3222 to schedule an appointment. Bring photo identification with you. No fees apply.

    • A Commissioner of Oath is available at all municipal offices (fees may apply), as well as some MP/MPP offices (no fees apply). Check the blue pages in the back section of your phonebook. Call ahead as some offices require appointments. Make sure you ask whether you need to bring one or two pieces of identification.

    • A Notary Public or a Justice of the Peace can also sign or stamp your affidavit. You would need to contact a legal office, and fees will apply.

  3. Return the ORIGINAL copy of the exemption form via mail to:

    Niagara Region Public Health
    Vaccine Preventable Disease Program
    P.O. Box 1052, Station Main
    Thorold, ON L2V OA2

Benefits of a Completed Vaccination Record

Once your child's exemption form is on file, your child will no longer risk suspension from school.

However, in the event of an outbreak of a vaccine preventable disease, your child will be excluded from attending school for the duration of the outbreak.

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