affidavit of parental consent

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AFFIDAVIT OF PARENTAL CONSENT For Travel Outside the United States of a Minor Child I, __________________________, parent/legal guardian of said minor child do hereby authorize _____________________________, age: ________ to travel to Guatemala with Christopher Baker of Harmony Bible Church, Danville, IA from July 23-30, 2016. We have major medical insurance that will cover said minor child for medical treatment and we authorize Christopher Baker and other trip leaders to make medical treatment decisions for said minor child if needed.

Signature ____________________________________________________ (signature of non-traveling birth parent/guardian—to be signed in front of a Notary Public only)

Subscribed and sworn to before me this _________ day of _______________, 20____ Signature of Notary Public:________________________________________________ Notary Public in and for the County of __________________, and the State of _______. My commission expires:_________________________________ Affix Notary seal at right side of page.