Parental Authorization For Minors (For Visa)

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FORM TO BE NOTARIZED WITH BOTH PARENTS SIGNATURE
PARENTAL AUTHORIZATION FOR MINORS (FOR VISA)
(Children under 18 years old)
I, the undersigned,
Mr
and
Mrs
Capacity (parents or legal guardians)
(Both parents or guardians should provide a copy of his / her ID card with signature and the child
birth certificate. If separated or divorced, or in case of adoption, the legal guardian should provide a
copy of the judgement.)
having full and complete custody of
Name of minor
Date of birth (day/month/ year):
Residing at
do hereby authorize my child to leave the United States of America,
from (day/month/year)
to (day/month/year)
(CITY and STATE)
Place : _________________________
Date : _________________________
Mother Signature _________________________
Father Signature _________________________

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