Exemption for Religious or Conscience Reasons:
If you are choosing not to immunize your school-aged child for religious or conscience reasons, you will need to:
Watch the vaccine education video:
Complete HKPR Vaccine Education Certificate Survey to receive a certificate.
Complete a Statement of Conscience or Religious Belief Form and have it signed and stamped by a commissioner of oaths, notary public, or a justice of the peace. There may be a cost to have the form signed and photo ID is required. Or, check with the Service Ontario location near you, as they may do it free of charge.
Note: Affidavit forms that have been altered e.g., additions or information crossed-out, are not accepted.
Submit the certificate and the completed, unaltered Statement of Conscience or Religious Belief Form to Public Health one of the following ways:
- Online, click here
- Email: immunization@hkpr.on.ca
- Mail: HKPR District Health Unit, Vaccine Records, 200 Rose Glen Road, Port Hope, ON L1A 3V6
- In Person: At any Health Unit office. Bring a printed copy of the certificate and completed form.
Keep a copy for your records.
Exemption for Medical Reasons:
If your child cannot be vaccinated for medical reasons, you will need to:
Have your doctor or nurse practitioner complete and sign the Statement of Medical Exemption Form.
Submit the completed Statement of Medical Exemption Form to Public Health one of the following ways:
- Online, click here
- Email: immunization@hkpr.on.ca
- Mail: HKPR District Health Unit, Vaccine Records, 200 Rose Glen Road, Port Hope, ON L1A 3V6
- In Person: At any Health Unit office. Bring a printed copy of the certificate and completed form).
Keep a copy for your records.