美國護照補辦

我現在有一個非常緊急的事情要麻煩大家幫個忙,我兒子的美國護照過期了,需要補辦,但是補辦新護照要父母雙方都要一起去AIT,可是我老公現在在國外工作,沒有辦法跟我一起去,所以需要一份缺席的父或母簽署並經公證後的一份同意書,可是我不知道要怎麼寫,可以請大家幫我打個草稿嗎??

http://travel.state.gov/content/passports/english/passports/under-16.html#consent

If one parent/guardian is unable to appear in person, then the DS-11 application must be accompanied by a signed, notarized Form DS-3053: Statement of Consent from the non-applying parent/guardian.