Immigration Guardianship Consent
1. Child(ren) Information
Full Name(s):
Date of Birth:
Passport Number:
2. Parent(s) / Legal Guardian(s) Information
Full Name(s):
Relationship to Child:
Contact Information:
3. Appointed Guardian Information
Full Name:
Relationship to Child:
Address:
Contact Information:
4. Consent Details
Duration of Guardianship:
Specific Consent Instructions:
5. Declaration
Declaration Statement:
Parent/Legal Guardian Signature
Date
Appointed Guardian Signature
Date