Last Updated: 02/14
LETTER OF CONSENT FOR TRAVEL OF A MINOR CHILD
In certain cases it may be suggested that you provide some form of letter of consent if
your child is traveling internationally with only one parent or with another adult, such as
a grandparent, aunt, uncle, etc. If you wish to provide this information with your
application, please feel free to download and include this letter. The sample letter below
is a guide only and you are free to include any information you wish or leave sections
blank if you do not wish to complete the entire letter. You may also choose if you wish
to have the letter of consent witnessed and/or notarized although this is not a requirement
to complete your application or submit your information.
Last Updated: 02/14
To Whom It May Concern:
I/We, _______________________________________________________________________________
(Full Name(s) of Custodial and/or Non-Custodial Parent(s)/Legal Guardian(s))
am/are the lawful custodial parent and/or non-custodial parent(s) or legal guardian(s) of:
Child’s full name:_____________________________________________________________________
Da
te of Birth:________________________________________________________________________
Place
of Birth:________________________________________________________________________
Passport Number:_________________________________________________________________
Date and Place of Issuance of
Passport:________________________________________________
____________________________________, has my/our consent to travel with:
(Child’s Full Name)
Full name of accompanying person:_______________________________________________________
Passport number: _________________________________________________________
____________
Date and Place of issuance of this passport:_________________________________________________
to visit_____________________________________ during the period of ________________________.
(Name of Country)
(Dates of Travel: Departure and Return)
During that period, _________________________________will be residing with
(Child’s Name)
____________________________________________________ at the following address:
(Name of Person Who Child will be Residing With at Intended Destination)
Number/Street Address& apartment number:_______________________________________________
City, State/Province, Country:___________________________________________________________
Telephone and/or Fax Number(
s) (work, mobile number & residence)___________________________
Signature:__________________________ ______________________ Date:___________________
(Signature of Custodial Parent, and/or Non-Custodial Parent or Legal Guardian)
F
ull Name: __________________________________________________________________________
Signature:__________________________ ______________________ Date:___________________
(Signature of Custodial Parent, and/or Non-Custodial Parent or Legal Guardian)
Full Name: __________________________________________________________________________
Signed before me, ____________________________________________________________________,
(Full Name of Witness)
this_____________________ at _________________________________________________________.
(Date) (Name of Location)
Signature:________________________________________________
