Algoma Public Health

Immunization Exemption

In some cases, a child may be exempt from immunization requirements due to medical or non-medical reasons. Medical exemptions include proof of serological immunity, a clinical diagnosis of disease, or because the child has true vaccine contraindication. Non-medical exemptions are due to conscience, philosophical or religious beliefs. Parents must choose one of the following steps to have their child’s exemption entered into the provincial immunization database. Once added, the exemption will be valid at any school or licensed child care centre in Ontario.

A separate exemption form is required for licensed child care and school attendance. If you have completed a non-medical exemption for child care, please note that you are still required to complete another exemption form when your child enters school. Once the school attendance exemption is applied, Public Health will no longer contact you about immunizations that your child is exempt from, and you will not receive immunization reminders. If you decide to have your child vaccinated later, you can cancel the exemption, ask your health care provider what immunizations are needed, or contact us to discuss a catch-up schedule for missing immunizations.

Please note that in the event of an outbreak related to a vaccine preventable disease, your child may be excluded from child care or school to protect them and the community.

For parents wanting to have their child exempt from licensed child care for medical reasons or for non-medical reasons, please follow the steps below.

Please note that these forms are legal documents and cannot be modified in any way (i.e. scratching out sections, writing comments on the form, etc.). Modified forms will not be accepted.

Vaccine Exemptions for Licensed Child Care Attendance

To Complete a Medical Exemption for Children Attending Licensed Child Care:

Have a physician or nurse practitioner complete and sign the Statement of Medical Exemption (CCEYA, 2014) form and indicate the reason for the exemption.
Make a copy of the document for your personal records.
Submit the signed form to Algoma Public Health in one of the following ways:

Drop off in-person at any Algoma Public Health location during regular business hours.
Fax (directly from your healthcare provider’s office) to 705.541.5959 (confidential fax).
Mail to:
Algoma Public Health
Attention: Immunization Program
294 Willow Ave.
Sault Ste, Marie, ON P6AB0A9

Or your local APH office in the Wawa, Blind River or Elliot Lake regions.

To Complete a Statement of Conscience or Religious Belief for Children Attending Licensed Child Care:

Step 1:

Download and complete the Statement of Conscience or Religious Belief (CCEYA, 2014) form. Have the form witnessed by a Commissioner for Taking Affidavits. A notarized form is required for each child in licensed child care. Please make copies of your form for your records.

Step 2:

Submit the original signed Statement of Conscience or Religious Belief form to APH in one of the following ways:

Drop off in-person at any Algoma Public Health location during regular business hours.
Fax (directly from your healthcare provider’s office) to 705.541.5959 (confidential fax).
Mail to:
Algoma Public Health
Attention: Immunization Program
294 Willow Ave.
Sault Ste, Marie, ON P6AB0A9

Or your local APH office in the Wawa, Blind River or Elliot Lake regions.

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. Please note that exemptions for licensed child care centres (as per the CCEYA) expire when your child starts school. An exemption for school aged-children will be required at that time.

Vaccine Exemptions for School-Aged Children

To Complete a Statement of Medical Exemption for Children Attending School:

Have a physician or nurse practitioner complete and sign the Statement of Medical Exemption form and indicate the reason for the exemption.
Make a copy of the document for your personal records.
Submit the signed form to Algoma Public Health in one of the following ways:

Drop off in-person at any Algoma Public Health location during regular business hours.
Fax (directly from your healthcare provider’s office) to 705.541.5959 (confidential fax).
Mail to:
Algoma Public Health
Attention: Immunization Program
294 Willow Ave.
Sault Ste, Marie, ON P6AB0A9

Or your local APH office in the Wawa, Blind River or Elliot Lake regions.

To Complete a Statement of Conscience or Religious Belief (Non-Medical) Exemption for Children Attending School

Step 1:

Watch the required vaccine education video.

If you have any questions or would like to speak to a nurse before proceeding, or if you do not have the ability to watch the video online, please call our Vaccine Phone Line at 705-759-5409, or your local APH office in the Wawa, Blind River or Elliot Lake regions.

Step 2: Fill out this form

Notify Public Health that you have completed the Immunization Education Session, by filling out the completion form (coming soon). If you are seeking an exemption for more than one child, please complete a form for each child.

If you have additional questions or are unable to complete this form, please contact us.

Public Health will provide you with a signed and dated Vaccine Education Certificate by email, which is required to proceed with Step 3 below. Please allow 10 business days to receive your certificate. The document will be password protected. The password will be the 10-digit number provided above without spaces or dashes. Please make a copy of this certificate for your records.

Step 3: Download and complete the Statement of Conscience or Religious Belief (Immunization of School Pupils Act) form.

Have the form witnessed by a Commissioner for Taking Affidavits. A notarized form is required for each child in school. Please make copies of your form for your records.

Step 4: Submit the original signed Statement of Conscience or Religious Belief form and a copy of the Vaccine Education Certificate to Algoma Public Health in one of the following ways:

Drop off in-person at any Algoma Public Health location during regular business hours.
Fax (directly from your healthcare provider’s office) to 705.541.5959 (confidential fax).
Mail to:
Algoma Public Health
Attention: Immunization Program
294 Willow Ave.
Sault Ste, Marie, ON P6AB0A9

Or your local APH office in the Wawa, Blind River or Elliot Lake regions.

Once Public Health has confirmed completion of the Immunization Education Session (through the completed form) and has received the original completed Statement of Conscience or Religious Belief form, the exemption will be entered into the provincial immunization database (Panorama). It is a valid exemption for any school in Ontario.

Terms of use

Before reporting vaccinations to Algoma Public Health, please read this information.

All of the information you submit is confidential and stored in a secure provincial immunization database (Panorama). It is important for everyone to keep track of their personal immunization record.

Algoma Public Health is required to maintain and review immunization records for every child (aged 0-17) who attends a school or licensed child care within the service area.

The information on children is collected, used and disclosed by Algoma Public Health within the authority of the Immunization of School Pupils Act, the Health Promotion and Protection Act, and the Child Care Early Years Act, to:

Review a child’s immunization record during an outbreak of a disease that would be preventable through immunization to determine if they are protected.
Regularly assess a child’s immunization status to ensure they meet the requirements to attend school or licensed child care.
Public Health only maintains vaccination records for children enrolled in licensed child care settings and schools.

Public Health does not maintain immunization records for individuals 18 years of age and older. Adults are encouraged to maintain their own immunization records, as records are sometimes required for post-secondary training, employment and international travel.

If you have any questions about your privacy or our collection and disclosure of this information, please review the Privacy section of our web site.