Authorization for Foreign Travel with Minor

AUTHORIZATION FOR FOREIGN TRAVEL WITH MINOR

To Whom It May Concern:

This letter is in relation to my child, _____________________________________________ [name of child], who is a citizen of the United States of America and a minor born on _________________________ [specify child’s date of birth].  My child holds a U.S. passport with the number _________________________.

I do solemnly swear that I have legal custody of my child and that no pending divorce or child custody proceedings involving my child exist.  I do hereby grant full authorization and consent for my child to travel outside of the United States with _________________________ [specify name of adult with whom child will travel], who is the _________________________ [specify adult’s relationship with child] of my child. The purpose of the travel is _________________________ [specify vacation, touring, to visit relatives, to accompany adult on business trip or other reason].  I have approved the following travel plans:

Dates of travel:                           Destinations/Accommodations:
_________________                  ______________________________________
_________________                  ______________________________________

I authorize _____________________________________________ [name of adult with whom child will travel] to make any changes whatsoever to the travel plans specified above.

Under penalty of perjury under the laws of the state of ______________________, I attest to the truthfulness, accuracy, and validity of the forgoing statement.
 

____________________________________                     ___________________
Parent 1's Signature                                                       Date
 

____________________________________                     ___________________
Parent 2's Signature                                                       Date

Parent #1:

Name: ________________________________________________________________________
Address:  ______________________________________________________________________
Home phone: __________________________      Work phone: __________________________
Cell phone: ____________________________      Pager: _______________________________
Email: ________________________________
Additional Contact Information: _____________________________________________________
_______________________________________________________________________________

Parent #2:
Name: ________________________________________________________________________
Address:  ______________________________________________________________________
Home phone: __________________________      Work phone: __________________________
Cell phone: ____________________________      Pager: _______________________________
Email: ________________________________
Additional Contact Information: _____________________________________________________
_______________________________________________________________________________
 

CERTIFICATE OF ACKNOWLEDGMENT OF NOTARY PUBLIC

STATE OF __________________
COUNTY OF ________________

Acknowledged before me on ___________________ [date] by __________________________________ [name of principal].

[Notary Seal, if any]:   

_______________________________
(Signature of Notarial Officer)

Notary Public for the State of __________________
My commission expires: ______________________