Washington Child Travel Consent Form: Minor Travel Consent with Health Care Authorization (RCW 7.70.065)

Child Travel Consent Form (Washington)

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 or passport card number: [Number] · Issuing country: [Country] · Expires: [Date]
Home address: [Street address], [City], Washington [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 have sole decision-making authority or custody under the parenting plan or order dated [date] in case no. [number], [county] County Superior Court (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] · Purpose of the trip: [Purpose]
Departure date: [Date] · Return date: [Date]

Date	From	To	Carrier, flight, crossing 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. A photocopy of each signing parent’s passport or national identity card is attached.

6. Authorization to Make Health Care Decisions (RCW 7.70.065(2)(a)(iv))

I/We authorize [companion’s name] to make health care decisions for the child, including giving informed consent to medical and dental treatment, while the child is in [his/her/their] care during the trip described above, if I/we cannot be reached in time.

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 (RCW 42.45.140)

State of Washington
County of ____________

This record was acknowledged before me on [date] by [name(s) of individuals].

___________________________ (Signature of notary public)
[Stamp]
[Title of office]
My commission expires: __________

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

Documents to Carry

• The child’s passport, passport card or other travel document the route requires, and a copy of the birth certificate
• This signed consent, with a photocopy of each signing parent’s passport or national identity card
• A copy of any parenting plan, 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 parenting plan first. Its travel and passport provisions control over this form, and taking a child from the other parent’s court-ordered time can be a felony (RCW 9A.40.060).

• Notarize it for international travel, and ask the destination’s embassy or consulate whether it needs an apostille or a translation. Canada says its letter does not need to be certified, but a notarized letter carries more weight.

• 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. For an arrangement of months rather than a trip, a parent can delegate powers over the child’s care and custody by a power of attorney for up to 24 months (RCW 11.130.145).