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MinistryofHealthInordertoreceiveavalidexemptionfornon-medicalreasons,parentsmust:Completetheimmunizationeducationsessionrequiredbythe ISPA;and.Parent/LegalGuardianInformationStepCompletetheStatementofConscienceorReligiousBeliefAffidavit.ThisformisontheOntarioGovernment CentralFormsRepositoryEnglishEStatementofConscienceorReligiousBeliefPDFDownload(Lastname)(Firstname)AddressYourcompletedStatement ofConscienceorReligiousBeliefneedstobecommissionedinordertoreceiveanon-medicalexemptionforyourchildfromvaccineimmunizataionrequirements Source:StatementofConscienceorReligiousBeliefForms,Links,andInformationDateofBirth(yyyy/mm/dd)AddressDateofBirth:(year)(month)(day) SchoolStatementofConscienceorReligiousBeliefPupil'sFirstNameImmunizationofSchoolPupilsAct,I,,parentofthefollowingnamedpupil:Pupil’sname ImmunizationofSchoolPupilsActPupilInformationPupil'sLastNameImmunizationofSchoolPupilsActRRO,REGULATIONGENERALCompletethe StatementofConscienceorReligiousBeliefformthatissigned,andswornoraffirmedbeforeaCommissionerforTakingAffidavitsStatementofConscienceor ReligiousMinistryofHealthandLong-TermCare.ConsolidationPeriod:FromMatoReturntheoriginalsignedcopyoftheStatementofConscienceorReligious BeliefAffidavitalongwiththePHUCoverLettertothePorcupineHealthUnitDONOTSIGNTHEFORMuntilStepIncludethenameofthevaccine(s)you wishyourchildtobeexemptfromreceivingintheboxabovetheparentsignatureTitle:StatementofConscienceorReligiousBelief,ChildCareandEarlyYears ActCreatedDate/10/AMStatementofConscienceorReligiousBeliefAffidavitStatementofIfyouhaveidednottoimmunizeyourchildfornon-medical reasons,youmustprovidealegalStatementofConscienceorReligiousBelief(ChildCare)formtothehealthunitStatementofConscienceorReligiousBelief FrenchFStatementofConscienceorReligiousReliefPDFDownloadStatementofConscienceorReligiousBelief–ImmunizationofSchoolPupils ActEnglisheStatementofConscienceorReligiousBelief–ImmunizationofSchoolPupilsActCentralFormsRepository(CFR)Ministries.(ClassorGrade)make oathorsolemnlyaffirmandsayasfollowsStatementofConscienceorReligiousBelief(FormE)NeighbourhoodNotaryPDFelarationofTitle:Statementof ConscienceorReligiousBelief,ChildCareandEarlyYearsActCreatedDate/2/PMDatasetdescription:Toallowindividualstoapplyforreligious/conscience exemptionsforimmunizationsToallowindividualstoapplyforreligious/conscienceexemptionsforimmunizationsIamtheparent/legal8, SHOWTABLEOF CONTENTSAparentmustcompleteaStatementofConscienceorReligiousBeliefandhaveitwitnessedbyacommissionerfortakingaffidavitsiftheywishto obtainanon-medicalIhaveaStatementofConscienceorReligiousBeliefAffidavitsignedbyaCommissionerofOaths,suchasalawyer,MemberofParliament, orTownClerk