AUTHORIZATION FOR FOREIGN TRAVEL FOR MINOR
(accompanied by one parent/guardian or parent with sole custody)*
To Whom It May Concern:
This letter is in relation to my minor child, ________________________________ [full name], who is a citizen of
the United States of America, born on ___ /___ / ______ in _____________ , ____ . This minor child holds a
United States passport bearing the number _________________ issued on ___ / ___ / ______ at
______________________ [place of issuance].
I, ________________________________________ [parent/guardian full name] do hereby authorize and give
consent for this minor child ________________________________ (full name] to travel outside the United States
of America to ________________ [destination] as well as to return to the United States of America as his/her
country of residence, under the responsibility of _________________________________ [full name of team
leader/parent/guardian-CIRCLE ONE] between the dates of ___ / ___ / ______ and ___ / ___ / ______.
(Signature by the parent/guardian NOT accompanying the minor child on the trip)
X
Father/Guardian: Print Name Signature Date
X
Mother/Guardian: Print Name Signature Date
Notary Certificate of Acknowledgement
Subscribed and affirmed before me this day of , 20 .
Affix Seal
Signature of Illinois Notary Public
A copy of the child’s birth certificate must accompany this form.
*NOTE: If you have sole custody of said child, you must attach a copy of custody papers. If the other
parent is deceased, you must attach a copy of the death certificate.