3042E Fillable Form: Statement of Conscience or Religious Belief for Child

The child care version of the statement

Licensed child care in Ontario follows its own rules on immunization. Under subsection 35(2) of Ontario Regulation 137/15, made under the Child Care and Early Years Act, 2014, a child care centre or home child care agency keeps either the child's immunization record or a parent's sworn statement. Form 3042E is that statement when the objection is one of religion or conscience.

It is a one-page affidavit. The parent names the child, the home address and the child care centre or agency, and swears or affirms two short statements before a commissioner for taking affidavits. The current edition is 3042E (2022/10).

Child care form or school form

What to write

Your name goes on the first line in the order the form asks, last name first: our page prints it that way for you. The child's name and date of birth should match the child care registration. For the last box, write the full name of the centre, or of the home child care agency that oversees the home your child attends.

When your child starts school, the school rules apply instead, and the school version, 4897-64E, goes to your public health unit.

Avoid these slips

1. First name first. The line reads "Last Name, First Name". We print it in that order.
2. One statement for two children. Each child needs their own statement. Add a second copy to the same booking.
3. Signed before the call. Leave it unsigned. You sign on the video call, after the commissioner checks your ID.

Swearing 3042E by video

Press Book and Sign and the statement is attached to your appointment. On the call you swear or affirm and sign on screen; the commissioner completes the "Sworn or solemnly affirmed before me" part. The sworn statement is emailed to you to give to your child care provider.