form 15 AUTHORIZATION FOR CHILD TO TRAVEL To whom it may concern

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form 15 AUTHORIZATION FOR CHILD TO TRAVEL To whom it may concern Powered By Docstoc
					                                                                                           [form 15]



                             AUTHORIZATION FOR CHILD TO TRAVEL

To whom it may concern:

The undersigned parent(s) authorize my/our child, _____________________________________, whose birth date
is ____________________________________, and whose passport number is ________________________, to
travel with __________________________________________ to _______________________________________
from ________________________, 20_____ until ________________________, 20_____.

I/we affirm that I/we have full legal rights and/or custody of said child and that there are no custody disputes
pending in any court.

I/we authorize _________________________________________________ to make any and all necessary decisions
regarding medical care.




Parent’s name __________________________________________________________________________________
Address _______________________________________________________________________________________
City, state, zip __________________________________________________________________________________
Day phone ____________________________________________________________________________________
Evening phone _________________________________________________________________________________
Cell phone ____________________________________________________________________________________
Pager _________________________________________________________________________________________




Parent’s name __________________________________________________________________________________
Address _______________________________________________________________________________________
City, state, zip __________________________________________________________________________________
Day phone ____________________________________________________________________________________
Evening phone _________________________________________________________________________________
Cell phone ____________________________________________________________________________________
Pager _________________________________________________________________________________________
 [signature]
___________________________________________    [signature]
                                              ___________________________________________
Signature                                     Signature

___________________________________________
(Typed Name of Acknowledger)

NOTARY PUBLIC

Commission Number: ________________________

My Commission Expires:

				
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posted:1/16/2012
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Description: Authorization Travel Child Form document sample