Fillable Printable Letter of Consent for Travel of a Minor Child - U. S. Department of State

Letter of Consent for Travel of a Minor Child - U. S. Department of State

Last Updated: 11/08

LETTER OF CONSENT FOR TRAVEL OF A MINOR CHILD

Because of increasing instances of child abduction in custody cases, and a growing

number of children who are the victims of trafficking or pornography, an immigration

officer, airline, or travel company may ask you to provide some form of letter of consent

if your child is traveling internationally with only one parent or with another adult, such

as a grandparent, aunt, uncle, etc. The sample letter below is a guide only. You may also

wish to have the letter of consent notarized.

Last Updated: 11/08

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:________________________________________________________________________

Place of Birth:________________________________________________________________________

U.S. Passport Number:_________________________________________________________________

Date and Place of Issuance of U.S. Passport:________________________________________________

____________________________________, has my/our consent to travel with:

(Child’s Full Name)

Full name of accompanying person:_______________________________________________________

U.S. or foreign passport number:_________________________________________________________

Date and Place of issuance of this passport:_________________________________________________

to visit_____________________________________ during the period of ________________________.

(Name of Foreign Country) (Dates of Travel: Departure and Return)

During that period, _________________________________will be residing with

(Child’s Name)

____________________________________________________ at the following address:

(Name of Person Who Child will be Residing With in Foreign Country)

Number/street address and apartment number:_______________________________________________

City, State/Province, Country:___________________________________________________________

Telephone and fax numbers (work, cell phone and residence)___________________________________

Signature:__________________________ ______________________ Date:___________________

(Signature of Custodial Parent, and/or Non-Custodial Parent or Legal Guardian)

Full Name: __________________________________________________________________________

Signature:__________________________ ______________________ Date:___________________

(Signature of Custodial Parent, and/or Non-Custodial Parent or Legal Guardian)

Full Name: __________________________________________________________________________

Signed before me, ____________________________________________________________________,

(Full Name of Witness)

this_____________________ at _________________________________________________________.

(Date) (Name of Location)

Signature:________________________________________________