Parents who want a non-medical immunization exemption for a child in licensed child care in Ontario use the government’s Statement of Conscience or Religious Belief for Child (form 3042E), made under the Child Care and Early Years Act, 2014. It is an affidavit, so it must be sworn or affirmed in front of a commissioner for taking affidavits. We commission it in Hamilton, in-office or by mobile visit.
Use the official Ministry of Education form below, not a retyped copy. We witness and commission the affidavit; we do not give advice about vaccination. For health questions, speak with your health care provider or public health unit.
What the form asks for
- The parent’s full name (last name, first name)
- The child’s last name, first name and date of birth (yyyy/mm/dd)
- The child’s home address
- The name of the child care centre or home child care agency
- The parent’s signature, made in front of the commissioner, who completes the “Sworn or solemnly affirmed before me” section
The parent swears that immunization conflicts with their sincerely held religious or conscientious convictions, and that the affidavit is made to comply with subsection 35(2) of Ontario Regulation 137/15.
Before your appointment
- Print the form and fill in the child’s details. Do not sign or date it.
- The parent named on the form must attend and bring valid government-issued photo ID.
- Need one for each child? Bring a separate form for each.
- For school-age children, use the school form instead: Statement of Conscience or Religious Belief, Immunization of School Pupils Act (014-4897-64).
Frequently asked questions
Does the child care vaccine exemption form need to be notarized?
Yes. Form 3042E is an affidavit. The parent must swear or affirm it in person before a commissioner for taking affidavits or a notary public, who signs it.
Can I sign the form before my appointment?
No. Fill in the child’s details, but leave the parent signature blank. You sign in front of the commissioner.
Is this the same form used for school?
No. Schools use a different form under the Immunization of School Pupils Act (form 014-4897-64), which also needs a vaccine education certificate from public health. A child care exemption does not carry over to school.
Where do I hand in the completed form?
Give it to your child care centre or home child care agency, and follow your local public health unit’s instructions. Keep a copy.
How much does it cost at Crown Seal Notary?
$45 for the first document and $15 for each additional document at the same visit, in our Hamilton office or by mobile visit.
Read more in our guide: How to get the child care vaccine exemption affidavit sworn in Hamilton.
Ready to have it sworn? Book an appointment or call or text 289-207-0851. $45 for the first document, $15 for each additional document at the same visit.