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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