Letter Of Consent For Travel Of A Minor Child (Page 2 of 2) in pdf

To Whom It May Concern:

I/We, _______________________________________________________________________________

(Full Name(s) of Custodial and/or Non-Custodial Parent(s)/Legal Guardian(s))

am/are the lawful custodial parent and/or non-custodial parent(s) or legal guardian(s) of:

Child’s full name:_____________________________________________________________________

Date of Birth:________________________________________________________________________

Place of Birth:________________________________________________________________________

Passport Number:_________________________________________________________________

Date and Place of Issuance of Passport:________________________________________________

____________________________________, has my/our consent to travel with:

(Child’s Full Name)

Full name of accompanying person:_______________________________________________________

Passport number: _____________________________________________________________________

Date and Place of issuance of this passport:_________________________________________________

to visit_____________________________________ during the period of ________________________.

(Name of Country)

(Dates of Travel: Departure and Return)

During that period, _________________________________will be residing with

(Child’s Name)

____________________________________________________ at the following address:

(Name of Person Who Child will be Residing With at Intended Destination)

Number/Street Address& apartment number:_______________________________________________

City, State/Province, Country:___________________________________________________________

Telephone and/or Fax Number(s) (work, mobile number & residence)___________________________

Signature:__________________________ ______________________ Date:___________________

(Signature of Custodial Parent, and/or Non-Custodial Parent or Legal Guardian)

Full Name: __________________________________________________________________________

Signature:__________________________ ______________________ Date:___________________

(Signature of Custodial Parent, and/or Non-Custodial Parent or Legal Guardian)

Full Name: __________________________________________________________________________

Signed before me, ____________________________________________________________________,

(Full Name of Witness)

this_____________________ at _________________________________________________________.

(Date)

(Name of Location)

Signature:________________________________________________

Last Updated: 02/14

Letter Of Consent For Travel Of A Minor Child Page 2