Sample Consent Letter for a Child Travelling

To Whom It May Concern

I (We), ________________ (full name(s) of custodial and/or non-custodial parent(s)/legal guardian(s)), am (are) the____________________ (lawful custodial parent and/or non-custodial parent(s) or legal guardian(s)) of

Child’s full name: _____________________________________
Date of birth (DD/MM/YY): _____________________________
Place of birth: ________________________________________
Canadian passport number:_____________________________
Date of issuance of Canadian passport (DD/MM/YY): ________
Place of issuance of Canadian passport: __________________

 

________________ (child’s full name), has my (our) consent to travel with

Full name of accompanying person: _______________________
Canadian or foreign passport number: _____________________
Date of issuance of passport (DD/MM/YY):_________________
Place of issuance of passport: ___________________________

to visit ______________ (name of foreign country) during the period of __________________ (dates of travel: departure and return). During that period, ________________ (child’s full name) will be residing with ________________ (name of person where child will be residing in foreign country) at the following address:

Number/street address and apartment number: ______________
City, province/state, country: _____________________________
Telephone and fax numbers (work and residence): _______________________

Any questions regarding this consent letter can be directed to the undersigned at:

Number/street address and apartment number: ______________
City, province/state, country: _____________________________
Telephone and fax numbers (work and residence): _______________________

Signature(s):______________________________________ Date:_________________
(Full name(s) and signature(s) of custodial parent, and/or non-custodial parent(s) or legal guardian(s))

Signed before me, ________________ (name of witness), this _________________ (date) at ________ ______ (name of location).

Signature: ________________ (name of witness)