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Authorization to Travel Internationally with a Minor
Legal Guardian: ________________________________
Address: ________________________________
City, State, Zip: ________________________________
Passport Number: _________________Date___________
State/Country: ________________________________
Minor Name: ________________________________
Address: ________________________________
City, State, Zip: ________________________________
Passport Number: _________________Date___________
State/Country: ________________________________
I, the legal guardian of the minor child mentioned above, hereby authorize the following person/people to accompany said child on an international trip:
Name: ________________________________
Address: ________________________________
City, State, Zip: ________________________________
Passport Number: _________________Date___________
State/Country: ________________________________
The trip shall last from _____________ to ____________ at the following addresses: ____________________________________________________
Signature _________________________ Date __________
Witness _________________________ Date __________
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