Power of Attorney

I/We designate __________________________ to provide accommodation for my/our son/daughter,

________________________________, to attend Eastern Mennonite School as an international
student from __________ to __________. This family has our authority to make minor medical
decisions on our behalf.
Students name (as it appears on the passport): ________________________________________
Students preferred name: __________________________________________________________
Host Family representatives name: ___________________________________________________
Host Family address: _______________________________________________________________
Phone: _______________ Cell:________________ Email: _________________________________
I/we understand that the International Boarding Coordinator will:
Visit the home of the host family prior to enrollment to determine that the living conditions are
of an acceptable standard.
Assess whether the designated caregiver will provide a safe physical and emotional
environment for the student.
Meet with the host family and establish communication with the host family.
Meet the student at least quarterly to ensure the accommodation is suitable.
I/we understand that Eastern Mennonite School will make every endeavour to ensure the safety and
welfare of my/our child while studying in their school.
Signed: __________________________________________ (Must be signed by students Parent)
Date: _______________________
Print Name: Mr/Mrs: ________________________________________________
Contact Telephone number in Home Country: ____________________________
Contact address in Home Country: _____________________________________
_________________________________________________________________
Email Address: _____________________________________________________