监护人声明中英文
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This ------Day of ----------(month)---------(year)
Signatue ofNotary: Official seal of Notary Public
STUDENT Information
Student's fullName XXX
Citizenship
Chinese
Date of Birth
08/10/1993
Sex
Male Female
Name and address of school in Canada
Address where student will reside in Canada
委托监护人声明
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
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
Host family arranged by Halton Homestay Service
PARENTS/GUARDIANSInformation (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
CUSTODIAN Information
Full Name
Status in Canada
Canadian citizen or
Permanent resident
Date of birth
Signature of parent/guardian (1): Date:
Signature of parent/guardian (2): Date:
Sworn before me at:------------(city), in the province of -------------(privince/territory), ----------(contry)
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
CUSTODIANSHIP DECLARATION-PARENTS/GUARDIANS
ห้องสมุดไป่ตู้05/09/59
Crrent residential address
phone
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. Ihave 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.
Signatue ofNotary: Official seal of Notary Public
STUDENT Information
Student's fullName XXX
Citizenship
Chinese
Date of Birth
08/10/1993
Sex
Male Female
Name and address of school in Canada
Address where student will reside in Canada
委托监护人声明
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
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
Host family arranged by Halton Homestay Service
PARENTS/GUARDIANSInformation (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
CUSTODIAN Information
Full Name
Status in Canada
Canadian citizen or
Permanent resident
Date of birth
Signature of parent/guardian (1): Date:
Signature of parent/guardian (2): Date:
Sworn before me at:------------(city), in the province of -------------(privince/territory), ----------(contry)
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
CUSTODIANSHIP DECLARATION-PARENTS/GUARDIANS
ห้องสมุดไป่ตู้05/09/59
Crrent residential address
phone
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. Ihave 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.