Travel Consent Form

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To: ________________________________________________________________________
From: ________________________________________________________________________
Re: Travel Consent Regarding Travel To: _________________________________________
I, ___________________________________________, ________________ (father/mother) of:
CHILD 1: ___________________________________ (Date of birth: _____________________),
CHILD 2: ___________________________________ (Date of birth: _____________________),
CHILD 3: ___________________________________ (Date of birth: _____________________),
CHILD 4: ___________________________________ (Date of birth: _____________________),
am giving my consent for the travel of my _________________________ (child, children), with
_________ (his/her/their) ________________ (mother/father) to:
Destination 1: ___________________________ . Date of travel: ________________________
Mode of travel: _________________________________ (plane, car, bus, train, etc.);
Address at first destination: ______________________________________________________
______________________________________ Contact telephone: _______________________
Destination 2: ___________________________ . Date of travel: _________________________
Mode of travel: _________________________________ (plane, car, bus, train, etc.);
Address at first destination: ______________________________________________________
______________________________________ Contact telephone: _______________________
Destination 3: ___________________________ . Date of travel: _________________________
Mode of travel: _________________________________ (plane, car, bus, train, etc.);
Address at first destination: ______________________________________________________
______________________________________ Contact telephone: _______________________
The expected date of return is: __________________________________ .
If you have any questions, please feel free to contact me at ________________________.
DECLARED before me at the City of )
_______________________, in the )
Province of ___________________ )
this ____ day of _______________ , )
20____ . )
)
)
) __________________________________________

____________________________ ) Signature
Commissioner of oaths )

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