Travel with One Parent Consent Template

Date: [Date]

1. Child Information

1.1 Child Full Legal Name: [Name]
1.2 Date of Birth: [MM/DD/YYYY]
1.3 Place of Birth (Optional): [City/Country]
1.4 Passport Number (if any): [Passport #]
1.5 Passport Issuing Country (if any): [Country]
1.6 Passport Expiration Date (if any): [Date]

2. Traveling Parent Information

2.1 Traveling Parent Full Name: [Name]
2.2 Relationship to Child: ☐ Mother ☐ Father ☐ Legal guardian ☐ Other: [Relationship]
2.3 Phone/Email: [Contact]
2.4 Address: [Address]
2.5 Passport/ID Number (Optional): [ID details]

3. Non-Traveling Parent/Guardian Giving Consent

3.1 Full Name: [Name]
3.2 Relationship to Child: ☐ Mother ☐ Father ☐ Legal guardian ☐ Other: [Relationship]
3.3 Phone/Email: [Contact]
3.4 Address: [Address]
3.5 Passport/ID Number (Optional): [ID details]

4. Trip Details

4.1 Destination(s): [Countries/Cities]
4.2 Travel Dates: From [Start Date] to [End Date]
4.3 Purpose of Travel: [Vacation / Family visit / School / Medical / Other]
4.4 Airline/Flight (Optional): [Airline, flight numbers]
4.5 Lodging Address(es) (Optional): [Hotel/host address]
4.6 Emergency Contact (Optional): [Name, phone, relationship]

5. Consent Statement

5.1 I, [Non-Traveling Parent/Guardian Name], am the ☐ mother ☐ father ☐ legal guardian of [Child Name].
5.2 I give my full consent for [Child Name] to travel with [Traveling Parent Name] to the destination(s) listed above during the stated travel dates.
5.3 I authorize [Traveling Parent Name] to make necessary travel decisions and obtain emergency medical care for the child during travel, if needed.

6. Custody Information (Optional)

6.1 Custody status: ☐ Joint custody ☐ Sole custody (attach proof) ☐ Other: [Details].
6.2 Relevant court order (if any): [Court, date, case number].

Signatures

Non-Traveling Parent/Guardian: [Full Name]
Date: [Date]
Signature: ___________________________

Traveling Parent (Optional Acknowledgment): [Full Name]
Date: [Date]
Signature: ___________________________

Notary / Notarization (Optional)

State of [State]
County of [County]

On [Date], before me, [Notary Name], personally appeared [Non-Traveling Parent/Guardian Name], known to me (or satisfactorily proven) to be the person whose name is subscribed to this document, and acknowledged that they executed it for the purposes stated.

Notary Public Signature: _______________________
My Commission Expires: _______________________
Notary Seal (if applicable): ___________________