监护人声明中英文

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XXXXXX生日20/11/196211/5/1968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：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CUSTODIANSHIPDECLARATION-PARENTS/GUARDIANSSTUDENTInformationStudent'sfullNameXXXCitizenshipChineseDateofBirth08/10/1993SexMaleFemaleNameandaddressofschoolinCanadaAddresswherestudentwillresideinCanadaHostfamilyarrangedbyHaltonHomestayServicePARENTS/GUARDIANSInformation(Preferablyfrombothparents/guardians)Parent/guardian1Parent/guardian2FullNameXXXXXXDateofbirth20/11/196211/5/1968HomeaddressphoneCUSTODIANInformationFullNameStatusinCanadaDateofbirthCanadiancitizenorPermanentresident05/09/59CrrentresidentialaddressphoneMy/ourchildwillreside:WithappointedcustodianintheschooldormitoryorwithanotherpersonI/We-------and-------(nameoftheparentsorguardians,theparents/guardiansofthesaidstudent---------(nameofstudent),herebygrantfullcustodianshipto-----------(nameofcustodian),duringthestudent'sstayinCanadawhilehe/sheisundertheageofmajorityintheprovinceinwhichhe/sheresides.Ihavemadethenecessaryarrangementsforthecareandsupportofthesaidstudentsuchthatthecustodianshouldactintheplaceofme/us,theparents.Bysigningthiscustodianagreement,I/WeaffirmthatIam/wearesatisfiedtheaboveappointedcustodianresideswithinareasonabledistanceofmy/ourchild'sintendedresidenceandschoolandwillbeabletofulfilhis/herobligationsasacustodianintheeventofanemergency.Signatureofparent/guardian(1):Date:Signatureofparent/guardian(2):Date:Swornbeforemeat:------------(city),intheprovinceof-------------(privince/territory),----------(contry)This------Dayof----------(month)---------(year)SignatueofNotary:OfficialsealofNotaryPublic