To contact HKPR, call 1-866-888-4577     CONTACT US
Minimize

Exemption Forms

The following forms allow parents/caregivers to exempt their child from immunization:

Statement of Conscience or Religious Belief Affidavit

Parents may complete this form for their infant or child if they are religiously or philosophically opposed to immunization.

The following are legal documents that must be notarized by a Commissioner of Oaths:

Statement of Conscience or Religious Belief Affidavit (ISPA - students age 4 to 17)

Statement of Conscience or Religious Belief - Child Care and Early Years Act, 2014 

Return the original copy to the Health Unit. The Health Unit cannot legally accept a fax or photocopy of the affidavit. If you require an original for your personal files, have the commissioner complete two forms.

Commissioners, who may charge a fee, include: Provincial Court Judge, Justice of the Peace, Head of Municipal Council, Clerk/Deputy Clerk/Treasurer/Deputy Treasurer of Local Municipality, and Barrister or Solicitor.

The affidavit may be withdrawn at any time, simply by providing the Health Unit with written notice.

Statement of Medical Exemption

The Statement of Medical Exemption is a form for children who require an immunization exemption for medical reasons (i.e. prior immunity or medical contraindication). A Physician or Nurse Practitioner must complete the form.

Completed exemption forms may be returned to your local Health Unit office.

If you have any further questions/concerns or require paper copies of the above exemption forms, call the Health Unit at 1-866-888-4577, ext 1507.