Affidavit Of Parental Consent For Travel Throughtout The United States Of A Minor Child Without Parents Traveling
Download a blank fillable Affidavit Of Parental Consent For Travel Throughtout The United States Of A Minor Child Without Parents Traveling in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Affidavit Of Parental Consent For Travel Throughtout The United States Of A Minor Child Without Parents Traveling with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1SUMMERFIELD BASKETBALL INC
AFFIDAVIT OF PARENTAL CONSENT
FOR TRAVEL THROUGHTOUT THE UNITED STATES OF A MINOR CHILD
WITHOUT PARENTS TRAVELING
TEAM NAME____________________TEAM GRADE____COACH _________________
I, __________________________________________________________________________, ____________________________________
Full name (first, middle & last) of the non-traveling parents(s) or legal guardian
Relationship of parents or legal guardian
DO HEREBY AUTHORIZE
OF _________________________________________________________________________,
Players full name (first, middle & last)
_________________________________________________________________________, ____________________________________
Full name (first, middle & last) of the person you authorize to travel with this child
Relationship of this person to player
OF_________________________________________________________________________, TRAVEL AS A GUARDIAN
Players full name (first, middle & last)
OF_________________________________________________________________________, AGE: _______________________________
Players full name (first, middle & last)
Players Age
Throughout the United States, including traveling by automobiles buses planes and trains. Overnight travel will include hotel,
motel or rental home stays while participating on the TAMPA BAY WARRIORS or ANY other teams organized by
SUMMERFIELD BASKETBALL INC from SEPTEMBER 1, __________ to AUGUST 31, ____________
Year
Year
MEDICAL RELEASE
I/We [__] HAVE
[__] DO NOT HAVE Major Medical Insurance that will cover _________________________________
Players full name (first, middle & last)
Primary Insurance Company
_______________________________________________________________________________________
Insurance ID Number
PLEASE PRINT
(If you have no insurance, please mark “N/A” )
For medical treatment within the United States; and that I/We [__] AUTHORIZE
[__] DO NOT AUTHORIZE
_____________________________________________ to make medical treatment decisions for ___________________________________
Name of the person you authorize to travel with this child
Players full name (first, middle & last)
if needed. We have provided EMERGENCY CONTACT INFORMATION BELOW:
NAME:__________________________________________________________________________________________________________
ADDRESS: _______________________________________________________________________________________________________
CITY: ____________________________________________________ STATE _____________________________ ZIP _______________
HOME PHONE ____________________________________________ WORK PHONE _________________________________________
CELL PHONE _____________________________________________ ALTERNATE PHONE ___________________________________
ALTERNATE NAME & PHONE _____________________________________________________________________________________
SIGNATURE ____________________________________________________________________________________________
PARENT OR LEGAL GUARDIAN (TO BE SIGNED IN FRONT OF A NOTARY PUBLIC ONLY)
STATE OF FLORIDA
COUNTY OF______________________________________
Sworn to and subscribed before me this _______ day of _________________, 20___, by__________________________________________
(Name of person making statement)
Personally Known ______ OR Produced Identification ______ Type of Identification Produced ____________________________________
Signature of Notary Public: ______________________________________________________
My Commission Expires: _______________________________________________
Affix Notary Seal or Stamp At The Right Side Of Page
Summerfield Basketball Inc PO Box 535 Riverview FL 33568 Phone 813.376.0587 Fax 813.671.9256
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal