Consent Letter For A Child Traveling

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Consent Letter for a Child Traveling
To Whom It May Concern:
I (We), _________________________________________________________________
(Full name(s) of custodial and/or non-custodial parent(s)/legal guardian(s), am (are) the
_________________________(lawful custodial parent(s) and /or non-custodial parent(s)
Or legal guardian(s) of:
Child’s Full Name: ________________________________________________
Date of Birth: _____________________________
Place of Birth: _____________________________
Passport Number: ______________________________________
Date of issuance of US passport (DD/MM/YY): _____________________
Place of issuance of US passport: ________________________________
________________________________(Child’s full name), has my (our) consent to travel with:
Full name of accompanying person: ____________________________________
US or foreign passport number: _______________________________________
Date of issuance of US passport (DD/MM/YY): __________________________
Place of issuance of US passport: ___________________________
To visit _____________________________(name of foreign country) during the period
of ______________________________________________(dates of travel: departure
and return). During the period, _______________________________(Child’s full name)
will be traveling with ____________________________________(name of person
whom child will be traveling with in the foreign country)
Any questions regarding this consent letter can be directed to the undersigned at:
Kevin Lovegreen
651-994-8748
4335 Matthew Ct.
Eagan, MN 55123
USA
Signature of Parent or legal guardian: _______________________________________
Print name: _________________________Date: ____________
Signature of Parent or legal guardian: ________________________________________
Print name: _________________________Date: ____________
Signed before me, _________________________(name of witness), this _____________
(date)
Witness signature: _____________________________________Notary Seal Here:
Print name: _____________________________

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