Exemption from School Vaccinations

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

If you choose to exempt your child from vaccinations for medical, religious or philosophical reasons, you need to submit a:

• Statement of medical exemption, or
• Statement of conscience or religious belief affidavit

There are things to keep in mind when you choose not to vaccinate your child.

Note: To avoid delay or having an incomplete form returned, read the following.

Statement of Medical Exemption

• A medical exemption must be completed by your health care provider.
• Niagara Region Public Health cannot legally accept a fax or photocopy of the exemption. If you require an original copy for your personal files, have your health care provider complete two exemptions.
• Please be advised that if you move to another public health unit area at a future date, you may be required to complete another exemption at that time

Complete these steps:

1. Download the form
   • Medical Exemption Form
   • Déclaration d'exemption médicale

   You can also call Niagara Region Public Health to have one mailed to you at
   905-688-8248 ext. 7425 or 1-888-505-6074

2. Completed exemption forms can be mailed or delivered in person to:

Main Office Location
Niagara Region Public Health
1815 Sir Isaac Brock Way, Campbell East, Thorold
Monday - Friday from 8:30 a.m. - 4:30 p.m.

Mailing Address
Vaccine Preventable Disease Program
c/o Niagara Region Public Health
P.O. Box 1052, Station Main,
Thorold, ON L2V 0A2

Statement of Conscience or Religious Beliefs Affidavit

• The affidavit must be signed and stamped by a commissioner of oath, notary public or a justice of the peace
• The Commissioner for Taking Affidavit must print their name (lawyers, print law society number), full address, telephone number, title and seal if available
• Niagara Region Public Health cannot legally accept a fax or photocopy of the affidavit. If you require an original for your personal files, have the commissionaire complete two forms.
• Please be advised that if you move to another public health unit area at a future date, you may be required to complete another Affidavit at that time

To exempt your child from vaccination for conscience or religious reasons, complete these steps:

1. Fill-out and print the form
   • Statement of Conscience or Religious Belief Affidavit
   • Déclaration de conscience ou de croyance religieuse

   You can also call Niagara Region Public Health to have one mailed to you at
   905-688-8248 ext. 7425 or 1-888-505-6074

2. Have the affidavit signed and stamped by a commissioner of oaths
3. Completed affidavits can be mailed or delivered in person to:

Main Office Location
Niagara Region Public Health
1815 Sir Isaac Brock Way, Campbell East, Thorold
Monday - Friday from 8:30 a.m. - 4:30 p.m.

Mailing Address
Vaccine Preventable Disease Program
c/o Niagara Region Public Health
P.O. Box 1052, Station Main,
Thorold, ON L2V 0A2

Commissioner of Oaths

A Commissioner of Oath is a person authorized to take your oath or solemn affirmation when you sign an affidavit or a statutory declaration.

• Commissioners of Oaths are: Regional Clerk or Deputy Regional Clerk; City Clerk or Deputy Clerk; Treasurers or Deputy Treasurers of municipalities; Justices of the Peace (for items of a legal nature); Lawyers; MP; MPP; Licensed Paralegals; Police Chiefs; some staff at the Service Ontario, Government Information Centre are Commissioners
• Some Commissioners will provide the service at no cost, others may charge a fee
• Multiple pieces of photo ID may also be required

The client should call to confirm the times that this service is available, if there is a cost before going and if an appointment is necessary.

Attending School after your Child is Exempt

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

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.

Public Health

Child Vaccinations

• Report Online (Form)
• School Vaccinations
• Vaccines are Safe