Docstoc

AUTHORIZATION FOR FOREIGN TRAVEL WITH MINOR

Document Sample
AUTHORIZATION FOR FOREIGN TRAVEL WITH MINOR Powered By Docstoc
					          AUTHORIZATION FOR FOREIGN TRAVEL WITH MINOR

To Whom It May Concern:

This letter is in relation to my child [insert name of child], ________________________
_________________________________________________, who is a citizen of the United
States of America and a minor born on [insert date of birth] _____________________.
My child holds a U.S. passport with the number _________________________________.

I do solemnly swear that I have legal custody of my child and that no pending
divorce or child custody proceedings involving my child exist. I do hereby grant full
authorization and consent for my child to travel outside of the United States with
chaperones for the Fullerton Sister City Association trip on which my child is
traveling as a Junior Ambassador.

I have approved the following travel plans:

Dates of travel:                              Destinations/Accommodations

Depart __________________________             __________________________________

Return___________________________             Los Angeles, California, USA

I authorize the FSCA-appointed chaperones to make any changes whatsoever to the
travel plans specified above.

Under penalty of perjury under the laws of the state of California, I attest to the
truthfulness, accuracy, and validity of the forgoing statement.


____________________________________                 _____________________
Parent 1’s Signature                                      Date


____________________________________                 _____________________
Parent 2’s Signature                                      Date

Parent #1:

Name: ________________________________________________________________________
Address: ________________________________________________________________________

Home phone: __________________________      Work phone: _____________________
Cell phone: ____________________________    Pager: __________________________
Email: _____________________________________________
AUTHORIZATION FOR FOREIGN TRAVEL WITH MINOR – CONTINUED

Additional Contact Information:

_________________________________________________________________________
_________________________________________________________________________

Parent #2:


Name: ________________________________________________________________________
Address: _________________________________________________________________________
Home phone: __________________________      Work phone: ______________________
Cell phone: ____________________________    Pager: __________________________
Email: ______________________________________


Additional Contact Information:
_________________________________________________________________________
_________________________________________________________________________


             CERTIFICATE OF ACKNOWLEDGMENT OF NOTARY PUBLIC

STATE OF __________________

COUNTY OF ________________



Acknowledged before me on ___________________ [date] by

_______________________________________________________ [name of principal].

[Notary Seal, if any]:

                                          __________________________________
                                          (Signature of Notarial Officer)

                                          Notary Public for the State of

                                          ___________________________________


                                          My commission expires:

                                          ___________________________________