STATUTORY DECLARATION
IN THE MATTER OF:
Name: __________________________
CANADA )
PROVINCE OF ALBERTA )
TO WIT )
WE, _________________________________ and __________________________________
Of the Hamlet of Sherwood Park, in the Province of Alberta, DO SOLEMNLY DECLARE THAT:
1. We are the biological father and mother and legal guardians of:
Student’s Full Name: ___________________________________
Date of Birth: ___________________________________
Place of Birth: ___________________________________
2. Our (my) child, _____________________________________ has our express permission to
travel with Trevor Cazemier and Michelle Anderson from Sherwood Park to Jamaica leaving
Alberta, Canada on March 25th , 2010 and returning to Alberta, Canada on April 4th, 2010.
3. In case of injury of sickness, we give our express permission for our child to receive any medical
treatment that may need to have administered to ensure their good health.
4. We recognize there are risks associated with any trip and hereby absolve Strathcona Christian
Academy and Elk Island Public Schools from all liability.
AND I (WE) MAKE THIS SOLEMN DECLARATION conscientiously believing it to be true and
knowing it is of the same force and effect as if made under oath.
DECLARED before me at the Hamlet of )
Sherwood Park, in the Province of Alberta, ) _____________________________________
This 3rd day of December, A.D. 2009 ) (parent one – to be signed when lawyer is present)
) Address: _____________________________
_____________________________________ _____________________________________
A NOTARY PUBLIC IN AND )
FOR THE PROVINCE OF ALBERTA ) _____________________________________
___________________, Barrister and Solicitor ) (parent two – to be signed when lawyer is present)
_____________________________ ) Address: ______________________________
_____________________________ ) ______________________________________
*No legal advice has been provided with this document.