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Statement of Conscience or Religious Belief (Form 4897-64E)

Your completed Statement of Conscience or Religious Belief needs to be commissioned in order to receive a non-medical exemption for your child from vaccine / immunizataion requirements. Your ​Neighbourhood Notary can help you commission your Statement of Conscience or Religious Belief. 

Statement of Conscience or Religious Belief (Form 4897-64E) notarization neighbourhood notary
​What is a Statement of Conscience or Religious Belief?

Ontario's Immunization of School Pupils Act (“ISPA”) requires that children and adolescents attending primary or secondary school show proof of immunization against the ISPA’s designated diseases unless they have a valid exemption.

In order to receive a valid exemption for non-medical reasons, parents must:
  1. Complete the immunization education session required by the ISPA; and
  2. Complete the Statement of Conscience or Religious Belief form that is signed, and sworn or affirmed before a notary public. 

​Parents must submit the above mentioned documents to the medical officer of health of their local public health unit.

To find the local public health unit in your area, click here. 

Information about vaccines and Ontario’s publicly funded immunization program is available here. 

To download the Statement of Conscience or Religious Belief form, click here.

To review the Ontario ISPA, click here. 

DISCLAIMER: information provided in this article is for informational purposes only. It may not be up-to-date and may not be accurate. It shall not be construed as legal advice. Please contact the relevant governmental entity or organization for the most up-to-date and accurate information.

Need help commisioning your Statement of Conscience or Religious Belief?
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*This document may be eligible to be commissioned online. ​
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Looking for another document to be notarized? See a full list of documents that may be notarized. ​

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Neighbourhood Notary is a notary public listing / advertising service for independent notary publics offering their services to the general public. All notary public and commissioner of oath services offered are provided independently of Neighbourhood Notary by each individual notary public. We do not endorse or approve any services provided by any notary public listed on this website. 

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