Exemption from School Vaccinations

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.

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 or call to have one mailed to you at 905-688-8248 ext. 7425 or 1-888-505-6074
  2. Have your health care provider complete the form
  3. Mail or deliver (in person) the completed form to:
    • Vaccine Preventable Disease Program
      c/o Niagara Region Public Health
      P.O. Box 1052, Station Main,
      Thorold, ON L2V 0A2
    • Deliveries accepted Monday - Friday, 8:30 a.m. - 4:30 p.m.

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.

If you move to another public health unit area at a future date, you may be required to complete another exemption at that time.

Statement of Conscience or Religious Beliefs Process

Mandatory documents now include a Vaccine Education Certificate. The Vaccine Education Certificate is obtained once you have watched a mandatory vaccine education module, available at your local public health office.

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

Parents who are considering a non-medical vaccine exemption, the Immunization of School Pupils Act requires you to have proper documents on file with Niagara Region Public Health.

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

  1. Call Niagara Region Public Health at 905-688-3762 or 1-800-263-7248 ext.7425 to book your mandatory education session with a public health nurse

  2. Complete the session with the nurse and watch the mandatory vaccine education module to obtain a Vaccine Education Certificate and a Statement of Conscience or Religious Belief Affidavit

  3. Complete the form and have it signed and stamped by a Commissioner of Oath, Notary Public, or Justice of the Peace
    • A Commissioner of Oath is available at Niagara Region Headquarters by appointment only. To make an appointment, call 905-685-4225 ext. 3224. This is a free service. Parent / legal guardian will be required to provide valid photo identification.
    • Local municipalities may also provide this service, however they may charge a fee. Call ahead in the event an appointment is required.

  4. Return the original exemption form by mail or in-person to Niagara Region Public Health, Vaccine Preventable Disease, along with a copy of your Vaccine Education Certificate
    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
  5. A copy of these documents will be attached to your child / children's electronic immunization record at Niagara Region Public Health; however, it is your responsibility to keep copies of these documents

Once the completed forms are on file with Niagara Region Public Health, that child will no longer risk suspension from school. However, in the event of a community outbreak of a vaccine preventable disease, the child may not be able to go to school until the outbreak is declared over.

This must be done to make every effort possible to protect unvaccinated children from getting a disease their immune system may not be able to fight.

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; Member of Parliament; Member of Provincial Parliament; 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 identification 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.

Municipal Office Address Phone Number
Fort Erie 1 Municipal Centre Dr. 905-871-1600
Grimsby 160 Livingston Ave. 905-945-9634
Lincoln 4800 South Service Rd. 905-563-8205
Niagara Falls 4310 Queen St. 905-356-7521
Niagara-on-the-Lake 1593 Four Mile Creek Rd. 905-468-3266
Pelham 20 Pelham Town Square 905-893-2607
Port Colborne 66 Charlotte St. 905-835-2900
St. Catharines 50 Church St. 905-688-4889
Thorold 3540 Schmon Pky. 905-227-6206
Wainfleet 31940 Highway #3 905-899-3463
Welland 60 East Main St. 905-735-1700
West Lincoln 318 Canborough St. 905-957-3346
Niagara Region Sir Isaac Brock Way 905-980-6000

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