Changing room occupants

[boscobeans]

Consent for National/International Travel with Adult

 

 

I, (print full name)________________________________ am the lawful Guardian (Father/Mother)of ________________________________born on ____DATE_________in______CITY—AND—STATE____.

 

My child, ________________, has my consent to travel with _____________and/or ________________ from ____________, to and from all locations; including but not limited to ____________, from __DATE__________to ___DATE________on ANY and ALL modes of Ground, Sea or Air Transportation.

 

In the event that my child requires medical treatment and I cannot be reached, __________________and/or _______________are authorized to make medical decisions in my stead.

 

Any questions regarding this consent can be directed to me at this address:

 

_____________________________________________

 

_____________________________________________

 

Home Phone: (_____)

 

 

THIS CONSENT SIGNED ON_________________/2006_DATE

 

 

__________________________________________________________

SIGNATURE OF PARENT

 

NOTARIZED_________________________

____________________________________

____________________________________ NOTARY

SEAL