By signing this form, we declare that we are the legal parents of the

INTERNATIONAL STUDENT PROGRAM – HOMELAND PARENT TRAVEL CONSENT FORM
Hastings and Prince Edward District School Board
156 Ann Street, Belleville, Ontario, Canada K8N 3L3
Telephone: 1-613-966-1170 Fax: 1-613-966-1363
Email: [email protected]
To Whom It May Concern:
We
are the parents of:
Student’s full name:
Date of birth (DD/MM/YY):
Passport number:
Current homestay address:
Phone number:
has our permission to travel by him/herself to visit
from
until
. During this period,
will be residing with
at the following address
Phone numbers:
Any questions regarding this consent letter please contact homeland parents at (address & phone number):
By signing this form, we declare that we are the legal parents of the child listed above and authorized to grant
such permission. We declare that we take complete responsibility for the child’s safety and well-being from
the time he/she leaves his/her homestay until he/she returns. We understand the risks associated with our
child travelling alone, particularly in large cities – traffic, getting lost, language difficulties, robbery etc. – and
give our informed consent to the abovementioned travel.
Signature of parent:
Date:
Signature of parent:
Date:
Witnessed before me
(name) at
in the province/territory of
This
day of
(city),
, country of
(month)
.
(year)
**PLEASE FAX (613-966-1363) OR EMAIL [email protected] COMPLETED FORM ONE WEEK PRIOR TO TRAVEL**