Parental Consent Form for Children Travelling Abroad

Full name of 1st parent/legal guardian giving permission*
Full name of 2nd parent/legal guardian giving permission (if applicable)
My/Our “child”*
Mother/Father/Parents/Legal Guardian(s)*
- Parents
- Mother
- Father
- Legal Guardian(s)
My/our child’s date and place of birth
Birth Month*
Birth Day*
Birth Year*
My/our child’s place of birth*
Child's Temporary Guardian(s) My/Our child has my/our consent to travel with;
1st Temporary Guardian Full Name*
2nd Temporary Guardian Full Name (if applicable)
Name of foreign country*
Dates of Departure:
Departure Month*
Departure Day*
Departure Year*
Dates of Return:
Return Month*
Return Day*
Return Year*
During the time that my/our child is in my/our child’s temporary guardian’s custody, the said temporary guardian has the authority to make any medical decisions which may be required to be made.
Any questions regarding this consent letter can be directed to the undersigned at*
Phone Numbers:
Phone Type:*
- Work
- Home
- Cell
Phone Number:*
Today's Date:
Current Month*
Current Day*
Current Year*
Your email address*
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