Permission For International Travel
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1Permission for International Travel
For Applicants Under the Age of 18
Minor Information
Name
Trip Dates
Contact Information of Parent(s) or Legal Guardian(s)
Name
Street Address
City ST ZIP Code
Home Phone
Relationship
Legal Consent
I /We hereby give permission for my/our son/daughter (name)___________________________
to travel to Haiti from (trip date with mm/dd/yy) __________________ to __________________
accompanied by the following adults (please list, if applicable):
______________________________________________________________________________
______________________________________________________________________________
_________________________________________________________ ___________________
Signature of Parent/Guardian
Date
_________________________________________________________
Printed Name
_________________________________________________________ ___________________
Signature of Parent/Guardian
Date
_________________________________________________________
Printed Name
Please complete and mail a copy to:
Many Hands for Haiti
P.O. Box 204
Pella, IA 50219
You must also keep a copy to carry with you while traveling.
Applications will not be processed until this form has been received.
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Parent category: Business