Consent for International Travel
Without Supervision
I, ________, of ________, declare that I am the parent/legal guardian of the following child:
________, Male, born on ________ in ________, passport number ________
My child has consent to travel to ________ from ________ to ________, without an adult present.
Special Medical Needs and/or Allergies
My child has the following special medical needs and/or allergies:
________
If there are any questions or concerns regarding this document, I may be contacted at:
________
________
Phone: ________
Email: ________
__________________________________
________
__________________________________
WITNESS SIGNATURE
__________________________________
WITNESS NAME
__________________
DATE
Consent for International Travel
Without Supervision
I, ________, of ________, declare that I am the parent/legal guardian of the following child:
________, Male, born on ________ in ________, passport number ________
My child has consent to travel to ________ from ________ to ________, without an adult present.
Special Medical Needs and/or Allergies
My child has the following special medical needs and/or allergies:
________
If there are any questions or concerns regarding this document, I may be contacted at:
________
________
Phone: ________
Email: ________
__________________________________
________
__________________________________
WITNESS SIGNATURE
__________________________________
WITNESS NAME
__________________
DATE
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