Can I have a Statement of Conscience or Religious Belief affirmed online?

Yes! You can complete your Statement of Conscience or Religious Belief – Immunization of School Pupils Act (Form 4897-64E) online. 

This statement must be sworn or affirmed by a notary public or commissioner of oaths — which can be done online too. You can meet with a notary public via secure video call and get your form notarized in under 7 minutes. Get your form notarized instantly, or schedule a later notary appointment with NotaryPro today.

What is a Statement of Conscience or Religious Belief?

A Statement of Conscience or Religious Belief – Immunization of School Pupils Act (Form 4897-64E) grants children a valid exemption from being vaccinated against ISPA’s designated diseases. 

This statement is sometimes called a Children’s Vaccine Exemption Letter or a Children’s Vaccine Exemption Affidavit. A vaccine exemption prevents the medical officer of health from suspending a child for failure to immunize. This form is for non-medical reasons, such as conscience or religious beliefs. 

Getting Your Statement of Conscience or Religious Belief Affirmed Online

There is an affidavit portion to your Statement of Conscience or Religious Belief form, which must be sworn or affirmed by a notary public or commissioner of oaths. Our licensed notary public professionals can notarize your form online, from the comfort of your home or office. Follow the below steps to get your form sworn or affirmed (notarized):

• Go to NotaryPro’s Find a Document service to download your form now! 
• Complete everything before the section, SWORN OR SOLEMNLY AFFIRMED before me. This is the affidavit portion of the form; it’s to be completed with a notary public or commissioner of oaths. 
• Once your form is completed, head to our booking portal to book your appointment. 
• Upload your completed statement and get it instantly notarized via video call, or schedule a future appointment at a later date.

Information Required for a Statement of Conscience or Religious Belief

To complete your form, you’ll need to provide your contact details and full name. You also must provide a few details about your child or adolescent, including:

• The name of their School
• Their home address
• Their date of birth
• Their first and last name
• The immunization(s) you would like them to be exempt from
• Their grade

For more information about this form and the next steps required to obtain an exemption, see our Guide to the Statement of Conscience or Religious Belief: Form 4897-64E.