Consent for International Travel


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Consent for International Travel We, _________________________________, declare that we are the lawful Guardians of ____________________, __ M __ F, born ___/___/_____ at ___________________________ (city, state, country of birth). ____________________ (student) has an American passport numbered: _________________________, which was issued on __/___/______ at US Department of State. Our child, ______________________, has our consent to travel with Christ Community Church of 5501 GW Carver, Ames, Iowa, 50010 to travel to: Ensenada, Mexico. Our child will be leaving the United States on or about Jul 6th, 2019, and returning to the United States July 13th, 2019. In the event that our child requires emergency medical treatment and we cannot be reached, Christ Community Church is authorized to consent to medical treatment in our stead. Any questions regarding this document may be addressed to us at: Parent(s) name(s) _____________________________________ Street Address ________________________________________ City, State Zip Code ____________________________________ USA Home Telephone: (___) ___-_____ Cellular Telephone: (___) ___-_____ Cellular Telephone: (___) ___-_____ Signed on this ___ day of _______, 2019 ___________________________ (signature) ___________________________ (Parent name)

_______________________________ _______________________________ (other parent name – if applicable)

_______________________________ Witness Signature _______________________________ Witness Name