COVID-19 Vaccine Exemption Request | Renison Student Experience and Housing

Renison University College (“Renison”) requires that all students living in residence at Renison be vaccinated against COVID-19 unless they have a valid exemption. An exemption may be granted for medical reasons, or any protected grounds under the Ontario Human Rights Code.

In order to receive a valid exemption, the student (or their parent or legal guardian if the student is under the age of 18) must complete the following form and accept the risks of not being vaccinated while living in Renison's residence facilities.

Risks of not being vaccinated:

You may be more likely to be exposed to the COVID-19 virus than others if you live in a group setting where the COVID-19 virus may transmit more easily.

COVID-19 can result in severe illness. Those who are at particular risk of developing more severe disease or outcomes from COVID-19 are people:

who are an older adult (increasing risk with each decade, especially over 60 years)
of any age with chronic medical conditions, including: lung disease, heart disease, high blood pressure, diabetes, kidney disease, liver disease, dementia, or stroke
of any age who are immunocompromised, including those with an underlying medical condition, such as cancer or those taking medications which lower the immune system, such as chemotherapy
living with obesity, such as having a body mass index (BMI) of 40 or higher

Vaccination is one of the most effective ways to protect our families, communities and ourselves against COVID-19. Evidence indicates that vaccines are effective at preventing serious outcomes, such as severe illness, hospitalization and death due to COVID-19. A growing body of evidence indicates that people fully vaccinated with an mRNA vaccine (Pfizer-BioNTech and Moderna) are less likely to have asymptomatic infection or to transmit COVID-19 to others.

Sources

I am filling this form out on behalf of:

myself

my child

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Phone Number

Student First Name

Student Last Name

Student Email

Student Phone Number

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Reason for Exemption Request

Medical Reason

Human Rights Code Reason

Please provide a brief explanation for your request:

I understand that by requesting an exemption to the COVID-19 vaccine, I assume all responsibility for the risks associated with contracting COVID-19 in residence.

Yes, I understand and accept the risks.

I understand that by requesting an exemption to the COVID-19 vaccine requirement, I am assuming all responsibility for any additional costs associated with quarantine upon my/my child's arrival or in the event quarantine is required after my/my child's arrival.

Yes, I understand.

I understand that should an outbreak occur in residence, the Region of Waterloo Public Health or the University may impose additional restrictions or requirements on me/my child for health and safety reasons which may not apply to other students in residence who have been fully vaccinated.

Yes, I understand.

I understand that I/my child may choose to be vaccinated at a later date and that the University hosts a COVID-19 vaccination clinic on campus.

Yes, I understand