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Authorization for Foreign Travel With Minor

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					                      Authorization for Foreign Travel With Minor


To Whom It May Concern:



This letter authorizes 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 ____________________, to
travel outside the United States.

[choose one of the following]

[ ] I affirm that I have legal custody of my child, which I share with
__________________________ [name of child's other parent who is traveling with child]. I
give my full authorization and consent for my child to travel outside of the United States with
___________________________ [name of child's other parent who is traveling with child], who
is the child's other parent.

[end Alternative 1]

[ ] I affirm that I have legal custody of my child and that I am the child's only legal parent.
[Attach copy of birth certificate showing that you are the only legal parent or, if the child's other
parent is deceased, copy of child's birth certificate and death certificate of other parent.] I give
my full authorization and consent for my child to travel outside of the United States with
___________________________ [name of person who is traveling with child], who is the
child's ________________ [relationship between child and adult traveling with child].

[end Alternative 2]

[ ] We affirm that we are the parents of ____________________ [child's name] and that we
share legal custody. We give our full authorization and consent for our child to travel outside of
the United States with ___________________________ [name of person who is traveling with
child], who is the child's ________________ [relationship between child and adult traveling
with child].
[End Alternative 3]

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: ____________________

Print name: ________________________________

Address: ______________________
         ______________________

Home phone: ____________________              Work phone: ____________________

Cell phone or pager: ____________________           Email: ____________________



Parent 2's signature: _____________________________________________________

Date: ____________________

Print 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 ___________________ ________________________,
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 entity upon behalf of which the person acted, executed the instrument.
                                        WITNESS my hand and official seal.
                                        _____________________________________
                                        Notary Public for the State of ______________
                                        My commission expires __________________
[NOTARY SEAL]

				
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