Child Travel Consent Form

CHILD TRAVEL CONSENT FORM

Child

Full legal name: [________________________________]

Date of birth: [__/__/____]

Home address: [________________________________]

Travel document type and number, if relevant: [________________________________]

Authorized trip

I/We authorize the child named above to travel:

☐ With the adult identified below ☐ Without an accompanying adult, under the carrier's arrangements identified below

☐ Within the United States ☐ Internationally

Departure place: [________________________________]

Destination(s), including country where applicable: [________________________________]

Departure date: [__/__/____] Return date: [__/__/____]

Carrier, flight, train, or other travel details, if known: [________________________________]

Address and telephone number where the child can be reached during the trip: [________________________________]

The consent is limited to this trip and ends on the return date above. Any different destination or later return requires my/our further written consent.

Accompanying or supervising adult

Full legal name: [________________________________]

Relationship to child: [________________________________]

Telephone and email: [________________________________]

Travel document type and number, if relevant: [________________________________]

If the child travels with a group, group name and contact: [________________________________]

If the child travels without an accompanying adult, carrier booking or supervision reference: [________________________________]

Parent or legal guardian consent

I/We consent to the travel described above. I/We state that I/we have authority to give this consent and that the trip does not conflict with any court order known to me/us. This form gives permission for travel only; it does not transfer custody or authorize medical treatment.

Consenting parent or guardian 1

Full legal name: [________________________________]

Relationship to child: [________________________________]

Telephone and email during travel: [________________________________]

Address: [________________________________]

Signature: [________________________________] Date: [__/__/____]

Consenting parent or guardian 2, if applicable

Full legal name: [________________________________]

Relationship to child: [________________________________]

Telephone and email during travel: [________________________________]

Address: [________________________________]

Signature: [________________________________] Date: [__/__/____]

Custody order or other authority document relevant to this trip, if any: [________________________________]

Emergency contact other than the traveler, if desired: [NAME, RELATIONSHIP, PHONE]

Optional notarial acknowledgment

State or country: [________________________________]

County or locality: [________________________________]

On [__/__/____], before me, [NOTARY NAME], personally appeared [NAME(S) OF SIGNER(S)], whose identity I verified by [METHOD], and acknowledged signing this child travel consent form.

Notary signature: [________________________________]

Seal, commission number, and expiration, if applicable: [________________________________]

Source

U.S. Customs and Border Protection, Know Before You Go: Traveling Abroad