minortvlform

FORM FOR MINOR CHILDREN TRAVELING OUTSIDE UNITED STATES

IN WITNESS WHEREOF AND BY SIGNING BELOW, I APPROVE TRAVEL WITH

Adult Name____________________________TO (Destination or Type of Travel) ____________________________

DURING (Dates)____________FOR (Child Name) _____________________________Birthdate_______________

If the adult person traveling with my child is not the child's parent, I authorize adult person traveling with my child to obtain any necessary medical treatment by a licensed physician/ hospital / pharmacy/ rescue squad/ ambulance company / medical air evacuation company. In the event the adult person traveling with my child is incapacitated and cannot give authorization for treatment, I authorize a licensed physician/ hospital/ pharmacy/ rescue squad, ambulance company /medical air evacuation company to give my child any necessary medical treatment. I can be reached at ______________ phone number for followup, but I do want treatment to commence prior to my being contacted if my child is in pain or the condition is life threatening.

SIGNATURES:

Birth Mother Printed Name _____________________________Signature_________________________________

Birth Father Printed Name _____________________________Signature _________________________________

Legal Guardian Printed Name (If applicable)_________________________________________________________

Signature____________________________________________________________________________________

Witness Printed Name ________________________________Signature__________________________________

Witness Printed Name________________________________Signature__________________________________

I, a Notary Public of said County and State aforesaid, hereby certify that _________________________ and/or ____________________________appeared before me and swore to me and to the witnesses shown below in my presence that this instrument is their permission for the above mentioned child to travel with, travel to, and during dates mentioned above with the above said person. This document also includes authorization of medical treatment for the child if necessary. I attest that this instrument is executed willingly and voluntarily, without being coerced, by the above signor(s), and it is their free act and deed for the purposes of expressing their approval. In the circumstance of one parent or both parents being deceased or that the birth parents do not have child custody, I attest that the surviving parent or legal guardian swore to the accuracy of the death certificate(s) and/or guardianship documents attached to this document in my presence.

I further certify that the witnesses signing above also appeared before me and swore that they witnessed the legal birth mother's and/or legal birth father's OR legal guardian's signature of this document. It is further concluded that these witness attest that the signor(s) are of sound mind and signed this instrument voluntarily and have not been coerced. These witnesses have attested that any death certificates and/or guardianship documents are legal and certified.

Subscribed and sworn to before me this _________day of ______________________, 200______________

Signature of Notary Public:_________________________________________________________________

Notory Public in and for the County of____________________________, And State of __________________

My Commission Expires __________________________________________________________________

Seal:

Prepared by: Stoney Creek Travel, 16 Camelfield Rd., Weaverville, NC. Phone: 828-658-2582.

IMPORTANT FORM INFORMATION:

In addition to the child's citizenship documentation, a minor child under the age of 18 must have a legal guardian, or parental consent from their birth parents to exit the United States and to enter most foreign countries.

1. If Both Birth Parents Are Alive: If both birth parents are alive and one or both of them will NOT be traveling with minor children, the non-traveling parent(s) must complete and sign the form giving a notarized affidavit of consent to the person(s) traveling with their child(ren), granting their authorization to take the child(ren) in and out of the United States or to allow the minor child to travel on their own with no guardian.

2. One Birth Parent Is Deceased: If one birth parent is deceased, the surviving parent only needs a certified copy of the birth parent death. If the surviving parent IS NOT traveling with the minor child(ren), the certified death certificate is required in addition to this form.

3. Guardian For Minor Child: If both birth parent's are deceased or do not have legal custody of their child(ren), and the legal guardian is traveling with the minor child(ren), a certified guardianship papers are required. If there is more than one legal guardian, and one is not traveling with the other legal guardian and minor child(ren), a certified copy of guardianship papers is required in addition to this form. If there is more than one legal guardian and none are traveling with minor child(ren), certified guardianship papers are required in addition to this form.