Custodianship Declaration custodianship Form STUDENT INFORMATION Family name Given name Citizensip Date of birth Gender Female Male X Another gendre Name of school in Canada Address of school in Canada Address where student will reside in Canada PARENTS/GUARDIANS INFORMATION (Preferably from both parents/guardians) Parent/Guardian1 Family name Given name Date of birth Home Address Telephone number Email Parent/Guardian2 Family name Given name Date of birth Home Address Telephone number CUSTODIAN INFORMATION Family name Given name Status in Canada Canadian citizen Permanent resident Date of birth Current residential address Telephone number My/Our child will reside: with the appointed custodian in the school dormitory with another person
