Minor Travel Consent Form

Child
Child Name: Hazuki
Foster
DOB: 12 Aug 2015 Place of Birth: Kobe City, Japan
U.S. Passport No.: 545624803 Place of Issuance: Osaka, Japan
Destination:
Dates From: Tokyo To: Indianapolis
Airline: American Airlines Ticket No.: 0011170707851
Departure Date: 13 Feb Departure Time: 6:20 p.m.
Airline: American Airlines Ticket No.: 0011170707851
Return Date: 20 April Return Time: 3:55 p.m.
Accompanying
Adult
Adult Name: Kyle F
Foster
U.S. Passport No.: 470591974 Place of Issuance: America
Residence at (mothers house) 3645
Destination: Delmar. Endless, IN
Hotel Confirmation N/A
No.:
Legal Guardian(s)
Guardian 1: Kyle F Foster Relationship: Father
Guardian 2: Toshiko Foster Relationship: Mother
Address: 103SunnyHeights,5
16,3chome,Ogura,
SaiwaiWard,
KawasakiCity,Japan
Phone: Email: mofosterel@gmail.co
m
08025426886
I/we, Toshiko, and Kyle , the legal guardian(s) of
Hazuki Foster , consent to allow the child to
travel to the
aforementioned destinations
at the specified dates. I/we
also agree to allow the
previously mentioned adult
accompany and reside with
my/our child to the specified
destinations and residences.

Guardian 1 Signature Date

Guardian 2 Signature Date