Authorization for foreign travel with minor

							             Authorization for Foreign Travel With Minor


To Whom It May Concern:



This letter concerns my child, ____[name of child]____, a United States citizen and a
minor born on ____[child's date of birth]____, who carries a United States passport with
the number ____________________.

I affirm that I have legal custody of my child, and that there are no pending divorce or
child custody proceedings that involve my child. I give my full authorization and consent
for my child to travel outside of the United States with ____[name of adult with whom
child will travel]____, who is the ____[state adult's relationship with child]____ of my
child. The purpose of the travel is ____[specify vacation, touring, to visit relatives, to
accompany adult on business trip, or other reason]____.

I have approved the following travel plans:

Dates of travel:               Destinations/Accommodations:

____________________           ____________________________________________

____________________           ____________________________________________

Furthermore, I hereby authorize ____[name of adult with whom child will travel]____ to
modify the travel plans specified above as he/she deems necessary.



I declare under penalty of perjury under the laws of the state of ____________________
that the foregoing is true and correct.



Parent 1's signature: ___________________________

Date: _______________________________________

Printed name: ________________________________


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Address:

________________________________________________________________________

________________________________________________________________________

Home phone: _________________________                       Work phone: ___________________

Cell phone or pager: ____________________                   Email: ________________________



Parent 2's signature: ___________________________

Date: _______________________________________

Printed name: ________________________________

Address:

________________________________________________________________________

________________________________________________________________________

Home phone: _________________________                       Work phone: ___________________

Cell phone or pager: ____________________                   Email: ________________________




                     Certificate of Acknowledgment of Notary Public



State of _______________________________                    )
                                                            )         ss
County of _____________________________                     )


On _____________________, before me, ______________________________, a notary
public in and for said state, personally appeared ___________________
________________________, personally known to me (or proved to me on the basis of
satisfactory evidence) to be the person whose name is subscribed to the within
instrument, and acknowledged to me that he or she executed the same in his or her
authorized capacity and that by his or her signature on the instrument, the person, or the


                              Authorization for Foreign Travel With Minor          Page 2 of 3
entity upon behalf of which the person acted, executed the instrument.


I certify under PENALTY OF PERJURY under the laws of the state of ___________ that
the foregoing paragraph is true and correct.


                                            WITNESS my hand and official seal.
                                            _____________________________________
                                            Notary Public for the State of ______________
                                            My commission expires __________________
[NOTARY SEAL]




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