Affidavit - Authorization for Minor to Travel
Complete either A or B and C -  whichever is applicable

A.  I, (First, Middle, Last Name) ________________________________   hereby authorize my minor child (First, Middle, Last Name) ____________________________   to travel out of the United States from (date) _____________ to (date)______________ traveling to the country of _____________________ under the custody of (First, Middle, Last Name) ______________________________________ .

Signed: _____________________________________

B.  I, (First, Middle, Last Name) ________________________   hereby swear that I have sole custody of a minor child (First, Middle, Last Name) ____________________  and am authorized to take this minor child out of the United States from(date) ______ to (date)_________traveling to the country of __________________.

Signed: ____________________________________

C.  I, (First, Middle, Last Name) ________________________________   hereby authorize my minor child (First, Middle, Last Name) ____________________________   to receive any necessary medical treatment while traveling in the custody of the above mentioned person. 

Signed: ____________________________________

________________________________________________________________________

County of: _____________________________ State of: ___________________on this _________________ day of _____________, year ___________. 

Print name of above signatory:_________________________________appeared before me and, having duly sworn by me, stated that the contents of the foregoing application are true and complete, and signed the application in my presence.

       NOTARY SEAL                             ______________________________________

                                                           Notary Public Signature

For a minor under the age of 18 to travel out of the United States without both parents or legal guardians, a notarized affidavit must be obtained and presented to immigration officials upon departure and return to the United States.  Failure to present this affidavit may result in officials refusing the minor to leave the country.  Please complete and sign the appropriate portion A or B in front of a Notary Public, and carry this notarized affidavit with you.  It is recommended that you also carry divorce, custody, death certificates or any other supporting documents.