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Letter of Parental Consent for Minor Child to Travel

The intention of this letter is to provide consent for a minor child to travel without the company of both legal parents.
If neither parent is traveling with the minor child, then a Letter of Parental Consent must be completed separately by
each parent. Other official documentation may be required.

Consent:
I, ______________________________________________ (name of parent), am the ______ (mother) ______ (father) of
__________________________________ , aged ____________ , and do hereby give my consent for (him)(her) to travel
with __________________________________________________________________ (name/address of traveling adult),
______________________ (relationship to child), to ____________________________________________ (destination)
from _______________________ (date of first day of travel) until ______________________ (date of last day of travel).

Travel Details:
(Include flight numbers, arrival/departure times, cruise line, tour operator, or attach itinerary.)

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

Signature of Parent Giving Consent:


______________________________________________ (printed name) _________________________________
(address) ______________________________________
______________________________________________
(phone number) ________________________________

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Commonwealth of Pennsylvania
County of _________________________

This record was acknowledged before me on ____________________


by ______________________________________________________ . ______________________________
Notary Public
Official Stamp

Pennsylvania Association of Notaries • Phone: 800-944-8790 • Fax: 800-707-7075 • Web site: www.notary.org • E-mail: PAN@notary.org

PAN-326 4-23

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