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MINOR (CHILD) TRAVEL CONSENT
I. The Parent(s)
I/We, _______________________, am/are the lawful custodial parent(s) and/or non-custodial
parent(s) or legal guardian(s) of:
II. The Minor
Full Name: _______________________
Date of Birth: _______________________
Place of Birth: _______________________
Passport Number (if applicable): _______________________
o Country of Issuance: _______________________
o Date Issuance: _______________________
o Date Expiration: _______________________
III. Traveling Alone/Accompanying Person
- I authorize my child to travel alone.
- I authorize my child to travel with the following individual/organization:
Individual/Organization Name: _______________________
Relationship to Child (if applicable): _______________________
U.S. or Foreign Passport Number (if applicable): _______________________
o Country of Issuance: _______________________
o Date Issuance: _______________________
o Date Expiration: _______________________
IV. Itinerary
I authorize my child to travel to the following location _______________________ during the
period beginning on _______________________, 20____ and ending on
_______________________, 20____.
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V. Signature(s)
Parent / Legal Guardian Signature: ____________________________
Date: _______________________
Full Name: _______________________
Parent / Legal Guardian Signature: ____________________________
Date: _______________________
Full Name: _______________________
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