模板：为寄宿学校学生指定在美监护人的委托书

模板

请用英文版本发送。下方附参考译文。

LETTER OF APPOINTMENT OF U.S. GUARDIAN (LOCAL CONTACT)

To: [School name], [Dean of Students / International Student Office]
Date: [YYYY-MM-DD]

We, [parent 1 full name] and [parent 2 full name], the parents of [student's full name], born [YYYY-MM-DD], a student at [school name] in grade [grade], appoint the following adult as our child's guardian and local contact in the United States:

Name: [guardian's full name]
Relationship to the family: [e.g. family friend, aunt]
Address: [U.S. address]
Phone: [mobile] · E-mail: [e-mail]

From [start date] until [end date or "further written notice"], the guardian may, in our place:

1. Receive our child during school breaks, weekends away and holidays, and arrange travel to and from school.
2. Talk with the school about our child's well-being, attendance and academic progress.
3. Be contacted in an emergency and make urgent decisions if we cannot be reached, including authorizing emergency medical treatment.
4. [Other permissions, or delete this line.]

We can be reached at: [parents' phones, e-mails, time zone]. Please contact us as well as the guardian whenever possible.

Parent 1 signature: ______________________  Date: __________
Parent 2 signature: ______________________  Date: __________

I accept this appointment.
Guardian signature: ______________________  Date: __________

在美监护人（当地联系人）委托书

致：[学校名称]，[学生事务主任 / 国际学生办公室]
日期：[YYYY-MM-DD]

我们，[家长 1 全名]和[家长 2 全名]，是[学生全名]（出生日期 [YYYY-MM-DD]，[学校名称] [年级] 年级学生）的父母，现指定以下成年人担任我们孩子在美国的监护人和当地联系人：

姓名：[监护人全名]
与家庭的关系：[例如家庭朋友、姨妈]
地址：[美国地址]
电话：[手机] · 电子邮箱：[电子邮箱]

自[开始日期]起至[结束日期或“另行书面通知”]止，监护人可代表我们：

1. 在学校放假、周末外出和节假日期间接待我们的孩子，并安排往返学校的交通。
2. 就我们孩子的身心健康、出勤情况和学业进展与学校沟通。
3. 在紧急情况下作为联系人，并在无法联系到我们时作出紧急决定，包括授权紧急医疗救治。
4. [其他授权事项，或删除此行。]

我们的联系方式：[家长电话、电子邮箱、时区]。请尽可能同时联系我们和监护人。

家长 1 签名：______________________  日期：__________
家长 2 签名：______________________  日期：__________

本人接受此项委托。
监护人签名：______________________  日期：__________

USAnaru™ 原创模板——可自由复制和修改。这不是政府表格。