Minor Child Travel Consent Form

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MINOR CHILD TRAVEL CONSENT FORM
This certifies that (your name) has the permission of his/her undersigned parents/guardians to enter
(Country) to participate in an officially sponsored educational program for the dates of (Date). Thank
you for permitting him/her to enter your country.
Name of the responsible adult that will be accompanying the minor: ______________________
Signature of mother or guardian: ___________________________________________________
Printed/Typed name of mother or guardian: __________________________________________
Signature of father or guardian: ____________________________________________________
Printed/Typed name of father or guardian: ___________________________________________
Completed by Notary Public:
Province of _______________________________________________
Country of _______________________________________________
On this (date) day of (month) before me personally came (parents’/guardians’ names), known to me,
and known by me to be the parent or guardian of (your name).
Notary Public:
____________________________________________________________________________
Notary Signature Date ________________________________
Seal

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