Immunization Exemptions

Step 1: Complete the Statement of Medical Exemption form

• Have a physician or nurse practitioner complete and sign the Statement of Medical Exemption form (Ministry of Education) and indicate the reason for the exemption.
• Make a copy of the document for your personal records.

Step 2: Submit the signed form

• Submit the signed form to Public Health Sudbury & Districts in one of the following ways:
  • Drop off the signed form in person at any of our office locations during regular business hours.
  • Mail the signed form.
  • Fax the signed form directly from your health care provider’s office.

Step 1: Complete the Statement of Conscience or Religious Belief form

• Download and complete the Statement of Conscience or Religious Belief form (Ministry of Education).
• Have the form witnessed by a commissioner for taking affidavits.
• Note: A notarized form is required for each child in licensed child care.
• Make a copy of the document for your personal records.

Step 2: Submit the signed form

• Submit the original signed form to Public Health Sudbury & Districts in one of the following ways:
  • Drop off the signed form in person at any of our office locations during regular business hours.
  • Mail the signed form.

• Once Public Health has received the original completed Statement of Conscience or Religious Belief form, the exemption will be added to the provincial immunization database.
• This exemption is valid for any licensed child care in Ontario.
• Note: Exemptions for licensed child care centres expire when your child starts school. An exemption for school aged-children will be required at that time.

Step 1: Complete the Statement of Medical Exemption form

• Have a physician or nurse practitioner complete and sign the Statement of Medical Exemption – Immunization of School Pupils Act form (Ministry of Education) form and indicate the reason for the exemption.
• Make a copy of the document for your personal records.

Step 2: Submit the signed form

• Submit the signed form to Public Health Sudbury & Districts in one of the following ways:
  • Drop off the signed form in person at any of our office locations during regular business hours.
  • Mail the signed form.
  • Fax the signed form directly from your health care provider’s office.

Step 1: Watch the required Vaccine Education Video (below)

• If you have any questions or would like to speak to a nurse before proceeding, please contact us.
• If you do not have the ability to watch the video online, please contact us to arrange to watch the video in person at one of our offices.

Step 2: Submit the Vaccine Education Video Completion form

• Complete and submit the Vaccine Education Video Completion form.
  • If you are seeking an exemption for more than one child, please complete a form for each child.
• Public Health will provide you with a signed and dated Vaccine Education Certificate by email, which is required to proceed with Step 3.
  • Please allow 10 business days to receive your certificate.
  • Please make a copy of this certificate for your records.
  • The document will be password protected.
  • The password will be the 10-digit number provided above without spaces or dashes.

Step 3: Download and complete the Statement of Conscience or Religious Belief form

• Download and complete the Statement of Conscience or Religious Belief – Immunization of School Pupils Act form (Ministry of Education).
• Have the form witnessed by a commissioner for taking affidavits.
• Note: A notarized form is required for each child in licensed child care.
• Make a copy of the document for your personal records.

Step 4: Submit the documents

• Submit the original signed Statement of Conscience or Religious Belief form and a copy of the Vaccine Education Certificate to Public Health Sudbury & Districts in one of the following ways:
  • Drop off in person at any of our office locations during regular business hours.
  • Mail the documents.

• Once Public Health has received and reviewed your completed form confirming that you watched the Vaccine Education Video and has the original completed Statement of Conscience or Religious Belief form, the exemption will be entered into the provincial Panorama database.
• It is a valid exemption for any school in Ontario.