Texas Child Travel Consent Form: Notarized Minor Travel Consent with Medical Authorization

Child Travel Consent Form (Texas)

Consent of Parents or Legal Guardians for a Minor to Travel

1. Child

Full legal name: [Name]
Date of birth: [Date] · Place of birth: [City, state, country]
Passport number: [Number] · Issuing country: [Country] · Expires: [Date]
Home address: [Street address], [City], Texas [ZIP]

2. Parents or Legal Guardians

Parent or guardian 1: [Name] · Address: [Address] · Phone: [Phone] · E-mail: [E-mail] · ID: [Type and number]

Parent or guardian 2: [Name] · Address: [Address] · Phone: [Phone] · E-mail: [E-mail] · ID: [Type and number]

☐ Only one parent or guardian signs because (check one): ☐ I am the child’s sole managing conservator under the order dated [date] in cause no. [number], [court], Texas (copy attached) ☐ the other parent is deceased (death certificate attached) ☐ only one parent is named on the birth certificate ☐ other: [explain]

3. Travel Companion

☐ The child travels with one parent: [Name].
☐ The child travels with another adult: [Name], [relationship to the child], date of birth [date], passport or ID no. [number], phone [phone].
☐ The child travels with a group: [school, team or organization], led by [name and phone].
☐ The child travels alone as an unaccompanied minor and will be met at [place] by [name, phone].

4. Trip

Destination(s): [Cities and countries]
Departure date: [Date] · Return date: [Date]

Date	From	To	Carrier, flight or route	Staying at (address, phone)
[Date]	[City]	[City]	[Details]	[Details]
[Date]	[City]	[City]	[Details]	[Details]

5. Consent

I/We, the undersigned parent(s) or legal guardian(s) of the child named above, consent to the child traveling to the destination(s) listed above from [date] to [date] with the travel companion named in Section 3. I/We acknowledge that my/our son/daughter is traveling out of the country with [companion’s name], who has my/our permission to do so. This consent covers the trip described above only and may be revoked in writing at any time.

6. Authorization for Medical Treatment (Texas Family Code §§ 32.001, 32.002)

While the child is in the actual care, control and possession of [companion’s name], I/we authorize [companion’s name] to consent to medical, dental, psychological and surgical treatment of the child if I/we cannot be contacted. This is written authorization under Texas Family Code § 32.001(a)(5). It does not cover immunizations (§ 32.001(c)).

Allergies: [List] · Medications and doses: [List] · Conditions: [List]
Health insurance: [Insurer, member number, phone] · Child’s doctor: [Name, phone]

7. Contacts During the Trip

Parent or guardian 1: [Phone] · Parent or guardian 2: [Phone] · Emergency contact: [Name, relationship, phone]

8. Signatures

Parent or guardian 1: ___________________________ Printed name: [Name] Date: __________

Parent or guardian 2: ___________________________ Printed name: [Name] Date: __________

Notary Acknowledgment (Texas Civil Practice and Remedies Code § 121.008)

State of Texas
County of ____________

This instrument was acknowledged before me on [date] by [name or names of person or persons acknowledging].

___________________________ (Signature of officer)
[Title of officer]
My commission expires: __________
[Seal]

[If the parents sign at different times or places, attach a separate acknowledgment for each signer.]

Consent to Treatment (Completed by the Companion at the Time of Treatment; § 32.002)

Name of the child: [Name]
Name of one or both parents, and of any managing conservator or guardian: [Names]
Name of the person giving consent and relationship to the child: [Name, relationship]
Nature of the medical treatment to be given: [Description]
Date the treatment is to begin: [Date]

Signature of the person giving consent: ___________________________ Date: __________

Documents to Carry

• The child’s passport or other travel document the route requires, and a copy of the birth certificate
• This signed and notarized consent, with a copy of each signing parent’s photo ID
• A copy of any custody order or death certificate referred to in Section 2
• For a child leaving Mexico without a parent: the SAM form or other authorization Mexican immigration requires

Before You Travel (Delete This Section)

• Check your court order first. A decree with travel or passport restrictions controls over this form (Texas Family Code § 153.503).

• Notarize it, and ask the destination’s embassy or consulate whether it needs an apostille or a translation.

• Use a notary, not a “notario público.” A Texas notary witnesses signatures but cannot draft the document or choose the certificate for you, which is why the acknowledgment is included here, and the Secretary of State rejects documents that use the term “Notario Publico.”

• Passports are separate. For a child under 16, the non-applying parent’s consent goes on Form DS-3053 (22 CFR 51.28).

• Longer stays. If the child will live with a relative or caregiver for a longer period, consider an authorization agreement under Texas Family Code chapter 34 instead.