Authorization for Foreign Travel With Minor
To Whom It May Concern:
This letter concerns my child, 	 [name of child], a United States citizen and a minor born on 	 , [child’s date of birth], who has been issued a United States passport with the number	 . I affirm that I have legal custody of my child, and that there are no pending divorce or child custody proceedings that involve my child. I give my full authorization and consent for my child to travel outside of the United States with 	 [name of adult with whom child will travel], who is the 	 [state adult’s relationship with child] of my child. The purpose of the travel is 	[specify vacation, touring, to visit relatives, to accompany adult on business trip, or other reason].
I have approved the following travel plans:

 Dates of travel	 Destinations/Accommodations	

		

		

Furthermore, I hereby authorize 	 [name of adult with whom child will travel] to modify the travel plans specified above as he/she deems necessary.
I declare under penalty of perjury under the laws of the state of 	 that the foregoing is true and correct.
Parent 1’s signature: 	 Date: 	
Printed name: 	
Address: 		
Home phone: 	 Work phone: 	
Cell phone: 	 Email: 	
Parent 2’s signature: 	 Date: 	
Printed name: 	
Address: 		
Home phone: 	 Work phone: 	
Cell phone: 	 Email: 	

[OPTIONAL: ATTACH NOTARY CERTIFICATE]