AUTHORIZATION FOR FOREIGN TRAVEL FOR MINOR CHILD
(unaccompanied by either parent*)
To Whom It May Concern:
This letter is in relation to our minor child, ______________________ [full name], who is a citizen of the United States
of America, born on ___ /___ / ______ [birth date] in _____________ [city], ____ [state]. This minor child holds a United
States passport bearing the number _________________ [passport number] issued on ___ / ___ / ______ [date of issue]
at ______________________ [place of issuance].
We, ___________________________________________________________________ [parents/guardians full names]
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 ___ / ___ / ______ [departure date] and ___ / ___ /
______ [return date].
Father/Guardian: Print Name Signature Date
Mother/Guardian: Print Name Signature Date
Notary Certificate of Acknowledgement
Subscribed and affirmed before me this day of , 20 .
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.