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Adobe PDF Adobe PDF document  Statement of Conscience or Religious Belief – Immunization of School Pupils ActThe file you are about to download will ONLY work properly if opened with an Adobe Reader 10 or later client. Please do not open this file in a browser.Fill, Print & Save143.0 kb

Form Classification
Classification / Identification:
 Form Number:014-4897-64EEdition date: 2017/07 
 Title:Statement of Conscience or Religious Belief – Immunization of School Pupils Act
 Ministry:Health and Long-Term Care  
 Branch/ABC:Public Health  
 Program:Public Health  
 Purpose of Form:A parent must complete a Statement of Conscience or Religious Belief and have it witnessed by a commissioner for taking affidavits if they wish to obtain a non-medical exemption for their child from vaccine requirements under the Immunization of School Pupils Act.  

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