委托监护人声明-父母/监护人
学生信息 |
学生姓名 XXX | 国籍 中国 | 出生日 08/10/1993 | 性别 男 |
在加拿大的学校名称和地址： |
学生在加拿大住址： 希尔顿家庭住宿服务系统安排的接待家庭 |
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父母/监护人信息（最好父母两人的信息）： |
| 父母/监护人1 | 父母/监护人2 |
姓名全称 | XXX | XXX |
生日 | 20/11/1962 | 11/5/1968 |
家庭住址 | 北京市丰台区70号院4单元402室 | 北京市丰台区70号院4单元402室 |
电话 | | |
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管理人信息 |
姓名全称： 柯里斯廷W. 佛埃 | 在加拿大状况： 加拿大公民 或 永久居留 | 生日： 05/09/59 |
现住址： |
电话： |
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我们的孩子将与另一人 接待户家庭（请提供姓名并说明关系）
我们，XXX 和 XXX 是学生 XXX 的父母/监护人，在此授XXXXXXX.XXXXX全权管理上述学生在加拿大住宿的省份未达到成年之前的管理。我们已做好上述学生的各项照顾和生活
安排，管理人应该代表我们父母进行处理。我们签署此声明，确认指定的管理人居住地与我们孩子将要选择的居住地以及学校之间的距离适当，能够确保管理人在紧急情况下执行管理人职责。
父母/监护人（1）签字： 日期：
父母/监护人（2）签字： 日期：
于---------年--------月-------日，在---------国家---------省市，在我面前，作出上述声明。
公证员签字：--------------------- -------------------公证处盖章
CUSTODIANSHIP DECLARATION-PARENTS/GUARDIANS
STUDENT Information |
Student's full Name XXX | Citizenship Chine | Date of Birth 08/10/1993 | Sex Male Female |
Name and address of school in Canada |
Address where student will reside in Canada Host family arranged by Halton Homestay Service |
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PARENTS/GUARDIANS Information (Preferably from both parents/guardians) |
| Parent/guardian 1 | Parent/guardian 2 |
Full Name | XXX | XXX |
Date of birth | 20/11/1962 | 11/5/1968 |
Home address | | |
phone | | |
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CUSTODIAN Information |
Full Name | Status in Canada Canadian citizen or Permanent resident | Date of birth 05/09/59 |
Crrent residential address |
phone |
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My/our child will reside:
With appointed custodian in the school dormitory or with another person
I/We -------and -------(name of the parents or guardians, the parents/guardians of the said student---------(name of student), hereby grant full custodianship to -----------(name of custodian),during the student's stay in Canada while he/she is under the age of majority in the province in which he/she resides. I have made the necessary arrangements for the care and support of the said student such that the custodian should act in the place of me/us, the parents. By signing this custodian agreement, I/We affirm that I am/we are satisfied the above appointed custodian resides within a reasonable distance of my/our child's intended residence and school and will be able to fulfil his/her obligations as a custodian in the event of an emergency.
Signature of parent/guardian (1): Date:
Signature of parent/guardian (2): Date:
Sworn before me at:------------(city), in the province of -------------(privince/territory), ----------(contry)
This ------Day of ----------(month)---------(year)
Signatue of Notary: Official al of Notary Public
