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Child Travel Consent Form
The parties to this agreement are: ___________________________________________
AND
The parent / Guardian (Full name): ________________________________________
Contact details: __________________________________________________
The Child’s full name: _____________________________________________
Birth date: ____________________________
I hereby authorize the child to travel to the following destination(s):
_________________________________________________________________________
from ________________________ until ________________________.
I accept any additional costs that may incurred should it be deemed necessary for the child to be
returned home for emergency or misbehavior.
I declare that I _________________________ am the legal guardian of the child and that I have
the legal authority to grant him/her to travel.
Signature: _______________________________
Name: _______________________________ Relationship: ____________________________
Date: _____________________________________
Witness Signature: _______________________________
Witness Name: _______________________________