AUTHORIZATION FOR FOREIGN TRAVEL WITH MINOR This document is in relation to my child, _______________________________________[name of child], who is a citizen of ________________________________________(country) and a minor born on _____________[child ’s birthdate]. My child holds a passport with the number‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗ I do hereby grant full authorization and consent for my child to travel outside our country with [specify name of adult with whom child will travel], who is the [specify 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:
[name of adult with whom child I authorize will travel] to make any changes whatsoever to the travel plans specified above. I attest to the truthfulness, accuracy, and validity of the forgoing statement.
Parent 1 ’s Signature
Date
Parent 2 ’s Signature Parent #1: Name: Address: Home phone: Cell phone: Parent #2: Name: Address: Home phone: Cell phone:
Date
Work phone: Email:
Work phone: Email: CERTIFICATE OF ACKNOWLEDGMENT OF NOTARY PUBLIC
COUNTRY Acknowledged before me on [date] by [name of principal]. (Signature of Notarial Officer) Notary Public