Immunization Exemptions

If you live in Huron or Perth County, and are choosing not to immunize your child with childcare-required vaccines due to conscience or religious reasons, you will need to complete the following steps:

1. Complete a Statement of Conscience or Religious Belief, Child Care and Early Years Act and the Exemption Letter and Form below. Complete a form for each child you wish to exempt. 
   Childcare immunization exemption letter and form
2. Have the form(s) witnessed by a commissioner for taking affidavits. Bring a piece of identification with you when you have the commissioner witness your form(s).
3. Submit the completed original form(s) and Exemption Letter and Form to Huron Perth Public Health by mail or in person to our Clinton or Stratford | West Gore site.
4. We will copy the form(s) and give you back the original(s). Keep the originals in a safe location in your home. 
5. Submit a completed copy to your child’s childcare centre. 

Please note: these forms (childcare) will expire when your child begins school. You will need to complete a new exemption for children in school (K-12). 

Under the Commissioners for Taking Affidavits Act, persons authorized to sign affidavits for exemptions include:

• Members of the Assembly;
• Judges of the Court of Appeal for Ontario, the Superior Court of Justice, and the Ontario Court of Justice;
• Justices of the peace;
• Barristers and solicitors entitled to practice law in Ontario;
• Licensed Paralegals;
• Clerks, deputy clerks, treasurers, and deputy treasurers of local municipalities;
• Administrative heads and deputy administrative heads of departments responsible for building standards, welfare, assessment or planning;
• Heads of municipal councils, members of councils of lower-tier municipalities who are members of the council of an upper-tier municipality and members of councils of municipalities that have a population of at least 15,000;
• Persons licensed under the Law Society Act to provide legal services in Ontario.

The Commissioner for Taking Affidavits must be identified by printing their name (lawyers must provide their law society number), full address, telephone number, title and seal (if available).

If your child cannot be vaccinated for medical reasons, you will need to:

1. Have your healthcare provider complete and sign the Statement of Medical Exemption form.
2. Keep a copy of the completed form for your records then submit a copy to Huron Perth Public Health in one of the following ways:

• Email
• Fax 519-271-2785
• Mail to the Clinton or Stratford | West Gore site

If you live in Huron or Perth County, and are choosing not to immunize your child with school-required vaccines due to conscience or religious reasons, you will need to complete the following steps:

1. View the Ontario Ministry of Health’s online Vaccine Education Video.
2. After watching the video, complete the online form to request your Vaccine Education Certificate and submit information about you and the child(ren) you wish to exempt.
3. You will receive the Vaccine Education Certificate for your records, either by mail or email. 
4. Complete a Statement of Conscience or Religious Belief, Immunization of School Pupils Act form for each child you wish to exempt. 
5. Have the form(s) witnessed by a commissioner for taking affidavits. Bring a piece of identification and your Vaccine Education Certificate with you when you have the commissioner witness your form(s).
6. Submit the completed original form(s) to Huron Perth Public Health by mail or in person to our Clinton or Stratford | West Gore site.
7. We will copy the form(s) and give you back the original(s). Keep the originals in a safe location in your home. 

Under the Commissioners for Taking Affidavits Act, persons authorized to sign affidavits for exemptions include:

• Members of the Assembly;
• Judges of the Court of Appeal for Ontario, the Superior Court of Justice, and the Ontario Court of Justice;
• Justices of the peace;
• Barristers and solicitors entitled to practice law in Ontario;
• Licensed Paralegals;
• Clerks, deputy clerks, treasurers, and deputy treasurers of local municipalities;
• Administrative heads and deputy administrative heads of departments responsible for building standards, welfare, assessment or planning;
• Heads of municipal councils, members of councils of lower-tier municipalities who are members of the council of an upper-tier municipality and members of councils of municipalities that have a population of at least 15,000;
• Persons licensed under the Law Society Act to provide legal services in Ontario.

The Commissioner for Taking Affidavits must be identified by printing their name (lawyers must provide their law society number), full address, telephone number, title and seal (if available).

If your child cannot be vaccinated for medical reasons, you will need to:

1. Have your healthcare provider complete and sign the Statement of Medical Exemption, Immunization of School Pupils Act form.
2. Keep a copy of the completed form for your records then submit a copy to Huron Perth Public Health in one of the following ways:

• Email
• Fax 519-271-2785
• Mail to the Clinton or Stratford | West Gore site