Consent Letter For Child Travelling Abroad
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1CONSENT LETTER FOR CHILD TRAVELLING ABROAD
This form is to be filled out for a non-Canadian resident minor child travelling to Canada (
) with just one of their parents/guardians;
1
(
) accompanied only by a non-parent/guardian adult; or (
) alone.
2
3
(A) PARENT/GUARDIAN INFORMATION
Information for both parents/guardians must be filled out unless the child has only one legal parent/guardian. If so, please attach
copies of the legal custody decree or a copy of the death certificate.
Parent/Guardian 1
Parent/Guardian 2
Name:
Name:
Relationship to Child:
Relationship to Child:
Address:
Address:
Phone Number(s):
Phone Number(s):
(B) TRAVELLING CHILD INFORMATION
Child Name:
Birthdate:
Passport Country:
Passport Number:
Place of Birth (state/country):
Birth certification registration number:
(C) ACCOMPANYING PERSON INFORMATION
Fill this section out if your child will be accompanied by just one of their parents/guardians OR if they will be accompanied by a
non-parent/guardian. If your child is travelling alone, skip to section (D).
This child has my / our consent to travel under the care of the following individual to Fountainview Academy at
7615 Lytton-Lillooet Hwy, Lillooet, BC V0K 1V0, including crossing the border between the USA and Canada.
Adult Name:
Relationship to Child:
Passport Country:
Passport Number:
(D) DESTINATION AND CONTACT INFORMATION
This child has my/our consent to travel on their own (alone) with Fountainview Academy, including crossing the
border between the USA and Canada.
Fountainview Academy
Name and School Info:
School which holds a valid Certificate of Group 4 Classification to operate as a
secondary school in British Columbia, Canada
Location:
7615 Lytton-Lillooet Hwy, Lillooet, BC V0K 1V0 Canada
Travel Dates:
February 6-12, 2018
Contact Information:
250-256-5400; info@fountainview.ca; Cheryl Wiley - Director of Student Life
PARENT/GUARDIAN 1 CONSENT
PARENT/GUARDIAN 2 CONSENT
WITNESS
name of person giving consent
name of person giving consent
full name of witness (adult)
relationship to travelling child
relationship to travelling child
signature of witness
signature of person giving consent
signature of person giving consent
city, province/state
date (dd/mm/yyyy)
date (dd/mm/yyyy)
date (dd/mm/yyyy)
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