I/we ,
_____________________________________________________________________________ (parent(s) name)
Understand that my child:
_____________________________________________________________________________ (child's name)
_____________________________________________________________________________ (child's name)
_____________________________________________________________________________ (child's name)
Will be traveling to:
______________________________________ (name of country)
______________________________________ (date of travel)
Aboard Airline/Flight #
______________________________________
With:
_____________________________________________________________________________, (accompanying adults)
_____________________________________________________________________________, (accompanying adults)
Their expected date of return is:
____________________________________________
Signed:
_____________________________________________________________________________ (parent's name)
Signed:
_____________________________________________________________________________ (parent's name)
Address of Parent(s):
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Telephone/Contact:
_____________________________________________________________________________
Witness Signature:
_____________________________________________________________________________
Witness Print Name:
_____________________________________________________________________________
Notary Public Signature/Seal:
*Notary: Please include or attach the appropriate notarial wording prescribed by your state.