Affidavit of Consent for Children Travelling Abroad
full name(s) of parent(s) / person(s) / organization giving consent
am / are the parent(s), legal guardian(s) or other authorized person(s) or organization with custody rights, access rights or
parental authority over the following child:
Number and date of issue of passport (if
available):
Issuing authority of passport (if available):
country where passport was issued
Birth certificate registration number
Issuing authority of birth certificate
province / country where birth certificate was issued
This child has my / our consent to travel alone ☐ or This child has my / our consent to travel with
full name of accompanying person
mother, father, grandparent, sister, brother, relative, friend, other
Number and date of issue of passport:
Issuing authority of passport:
country where passport was issued
Contact Information during trip:
name of destination country / countries
date of departure to date of return
to stay with / at (if applicable)
name of person with whom child will be staying / hotel or other
accommodation
at the following address(es)
street address(es), city (cities)
province(s)/state(s), country (countries)
This affidavit must be signed before an official who has the authority to administer an oath or a solemn declaration.
Signature (s)of person(s)giving consent Subscribed and sworn before me
________________________(signature) this ___________ day of __________, 20_______
Name:
At _____________________________________
________________________(signature) ___________________________(Signature)
Name: Name of Official ___________________________
Date: Title:_____________________________________________________