This Child Travel Consent Form [Form] is executed on [Date], by and between:
Parent/Guardian Granting Consent:
Name: [Full Legal Name]
Address: [Address]
Phone: [Phone Number]
Email: [Email Address]
Accompanying Adult [If Applicable]:
Relationship to Child: [Relationship]
Child Information:
Full Name: [Child’s Full Name]
Date of Birth: [DOB]
Passport/ID Number [If Applicable]: [Number]
1. Transportation and Route Module
Complete the route and transportation table:
Date | Transport Type | From | To | Details [Flight/Train/Vehicle] |
[MM/DD/YYYY] | [Air/Rail/Car/Bus/Other] | [Location] | [Location] | [Carrier/Flight/Plate/Other] |
[MM/DD/YYYY] | [Air/Rail/Car/Bus/Other] | [Location] | [Location] | [Carrier/Flight/Plate/Other] |
[MM/DD/YYYY] | [Air/Rail/Car/Bus/Other] | [Location] | [Location] | [Carrier/Flight/Plate/Other] |
Date | Transport Type | From | To | Details [Flight/Train/Vehicle] |
[MM/DD/YYYY] | [Air/Rail/Car/Bus/Other] | [Location] | [Location] | [Carrier/Flight/Plate/Other] |
[MM/DD/YYYY] | [Air/Rail/Car/Bus/Other] | [Location] | [Location] | [Carrier/Flight/Plate/Other] |
[MM/DD/YYYY] | [Air/Rail/Car/Bus/Other] | [Location] | [Location] | [Carrier/Flight/Plate/Other] |
Date
Transport Type
From
To
Details [Flight/Train/Vehicle]
[MM/DD/YYYY]
[Air/Rail/Car/Bus/Other]
[Location]
[Carrier/Flight/Plate/Other]
2. Authorization to Travel
I/We, the undersigned parent(s) or legal guardian(s), authorize the above-named child to travel during the dates listed in Section 1 with the accompanying adult or organization identified above.
Authorized Geographic Area: [City/State/Country list]
Permitted Purpose of Travel: [Family visit/vacation/competition/other]
Complete the pickup and release table:
Event | Authorized Person | Phone | Location | Time Window |
[Departure pickup] | [Name] | [Phone] | [Location] | [Time] |
[Return pickup] | [Name] | [Phone] | [Location] | [Time] |
[Alternate pickup] | [Name] | [Phone] | [Location] | [Time] |
Event | Authorized Person | Phone | Location | Time Window |
[Departure pickup] | [Name] | [Phone] | [Location] | [Time] |
[Return pickup] | [Name] | [Phone] | [Location] | [Time] |
[Alternate pickup] | [Name] | [Phone] | [Location] | [Time] |
Event
Authorized Person
Phone
Location
Time Window
[Departure pickup]
[Name]
[Phone]
[Time]
[Return pickup]
[Alternate pickup]
4. Medical Authorization
I/We authorize the accompanying adult or relevant authorities to obtain and consent to medical treatment for the child in case of emergency during travel.
Insurance Provider [If Any]: [Name]
Policy/Member Number [If Any]: [Number]
Emergency Treatment Preferences [If Any]: [Preferences]
5. Lodging and Local Address Module
Lodging Name: [Hotel/Residence/Other]
Lodging Address: [Address]
Lodging Phone: [Phone Number]
6. Governing Law
This Form shall be governed by and construed in accordance with the laws of the State of [State].
7. Signatures
Parent/Guardian Signature: ________________________
Name: [Printed Name]
Date: [Date]
Parent/Guardian Signature [If Joint Consent Provided]: ________________________
Accompanying Adult Acknowledgment [If Applicable]: ________________________
8. Notary Acknowledgment [If Used]
This Form was acknowledged before me on [Date], by [Parent/Guardian Name(s)].
Notary Public: ________________________
My Commission Expires: [Date]
Date | Transport Type | From | To | Details [Flight/Train/Vehicle] |
[MM/DD/YYYY] | [Air/Rail/Car/Bus/Other] | [Location] | [Location] | [Carrier/Flight/Plate/Other] |
[MM/DD/YYYY] | [Air/Rail/Car/Bus/Other] | [Location] | [Location] | [Carrier/Flight/Plate/Other] |
[MM/DD/YYYY] | [Air/Rail/Car/Bus/Other] | [Location] | [Location] | [Carrier/Flight/Plate/Other] |
Event | Authorized Person | Phone | Location | Time Window |
[Departure pickup] | [Name] | [Phone] | [Location] | [Time] |
[Return pickup] | [Name] | [Phone] | [Location] | [Time] |
[Alternate pickup] | [Name] | [Phone] | [Location] | [Time] |