PERMISSION FOR A MINOR TO TRAVEL OUTSIDE OF UNITED …



PERMISSION FOR MINOR CHILD TO TRAVEL OUTSIDE OF THE UNITED STATES

I hereby grant permission to ________________________________________, (hereinafter “the Minor”),

FULL LEGAL NAME OF MINOR CHILD]

DOB _____/_____/________, who was born at ______________________________________________,

[MONTH / DAY / YEAR] [CITY, STATE, COUNTRY]

and who is my_______________________________________, to visit the following country or countries

[SON, DAUGHTER, WARD, ETC.]

__________________________________________________________________ solely for purposes of:

[SPECIFY COUNTRY / COUNTRIES TO BE VISITED BY MINOR]

( Tourism.

[OR]

( Visitation with the Minor’s other parent or guardian, _______________________________________.

[FULL LEGAL NAME OF PARENT/GUARDIAN]

The Minor shall depart the U.S. on or after ____/____/________ and return to no later than ____/____/________.

[MONTH / DAY / YEAR] [MONTH / DAY / YEAR]

( The Minor shall be accompanied by:_____________________________________________________,

[FULL LEGAL NAME OF ACCOMPANYING ADULT]

to whom I/we hereby grant permission to make emergency medical decisions in the event of illness/injury to the Minor.

[OR]

( The Minor will travel unaccompanied.

The Minor’s Parents/Guardians hereby agree that the Minor’s country of habitual residence (home country) is: _____________________________________________________________________.

[SPECIFY COUNTRY]

Signature: __________________________________________________ Date: _____/_____/________

[FULL LEGAL NAME OF PARENT / LEGAL GUARDIAN] [MONTH / DAY / YEAR]

Signature: __________________________________________________ Date: _____/_____/________

[FULL LEGAL NAME OF PARENT / LEGAL GUARDIAN] [MONTH / DAY / YEAR]

I, ______________________________________, a Notary Public in the state of____________, hereby certify that, on the _____ Day of ___________________, 2011, the above-signed Parties, ____________________________________ and ____________________________________, personally appeared before me, presented government-issued identity documents, signed the foregoing agreement, and have averred that the statements therein contained are true and correct.

Notary Public

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