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Immunisation exemption conscientious objection form

Conscientious objection form 2026

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The document is an Immunisation Exemption Conscientious Objection Form for the Australian Childhood Immunisation Register. It outlines the process for parents or guardians to formally declare their decision not to immunise their child based on personal, philosophical, religious, or medical beliefs. The form requires completion by a recognized immunisation provider and includes sections for parental declarations, provider declarations, and instructions for submission. It also emphasizes the importance of providing accurate information and includes privacy notices regarding the handling of personal data.

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Click ‘Get Form’ to open the conscientious objection form in the editor.
Begin by filling in the child's details, including their Medicare card number and family name. Ensure you print in BLOCK LETTERS for clarity.
In the 'Date of Birth' section, enter the child's date of birth accurately. Select the appropriate sex by marking the box next to 'Male' or 'Female'.
Complete the parent/guardian declaration by confirming that you have discussed immunisation benefits and risks with your provider. Sign and date this section.
Next, fill out the provider declaration, ensuring all information is complete and correct. The provider must also sign and date this section.
Once all sections are filled out, review your form for accuracy before sending it to the Department of Human Services via post or fax as indicated.

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2013	4 Satisfied (58 Votes)

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