Official Ontario form guide
Statement of Conscience or Religious Belief
Ontario’s prescribed Statement of Conscience or Religious Belief under the Immunization of School Pupils Act is used by a parent seeking a non-medical exemption from school immunization requirements for a child. Download the current form directly from Ontario and follow your local public health unit’s process.
This page does not host a duplicate form. Use Ontario form 014-4897-64 for school pupils and confirm that it remains current before signing.
What this form is for
The form records a parent’s statement of conscience or religious belief for a child covered by Ontario’s school immunization legislation. Ontario’s guidance says the parent must complete the required immunization education step, obtain the related certificate, complete the statement before a commissioner for taking affidavits, and submit the originals to the local public health unit.
School and child-care requirements are not interchangeable. Ontario maintains a separate form for certain child-care settings. If the child is not a school pupil, ask the child-care operator or local public health unit which prescribed form and procedure applies.
Before commissioning
- Contact the local public health unit and complete the immunization education process it directs.
- Download a fresh copy of the official provincial form for the correct setting.
- Enter the parent and child information exactly as it appears in school and public-health records.
- Review every field for spelling and date errors. If a prescribed form is altered or heavily corrected, ask the public health unit whether a new copy is required.
- Bring valid government-issued photo identification and the unsigned statement to the appointment.
- Keep the Vaccine Education Certificate and submission instructions with the form.
Sign only before the commissioner
The parent making the statement should not sign in advance. The commissioner must administer the oath or affirmation, observe the signature and complete the commissioner section.
After the appointment
- Check that the parent’s signature, commissioner’s jurat, date and location are complete.
- Make a clear copy of the commissioned statement and the education certificate for personal records.
- Submit the original documents to the local public health unit using its current instructions.
- Retain proof of delivery and respond directly to any request from public health for correction or additional information.
The commissioner witnesses the statement; they do not assess beliefs, give medical advice or approve an exemption. The local public health unit administers the process and can explain document delivery and record requirements.
Common questions
Is this a medical exemption form?
No. Ontario has a separate Statement of Medical Exemption completed by an authorized health professional. Ask the public health unit which route applies; a commissioner cannot give medical advice.
Can I use an older saved PDF?
Download the form from Ontario each time. Prescribed forms and instructions may change, and a local public health unit may reject an obsolete version.
Where do I send the form?
Ontario directs parents to submit the original statement and education certificate to their local public health unit. Contact that unit for delivery options and keep copies.
Need a commissioner or notary?
Bring the unsigned document, valid identification and the receiving organization’s instructions. Eligibility for online commissioning depends on the document and recipient.
