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| I ___________________________________________________provide
my consent for NAME OF PARENT |
| my child(ren) ____________________________________________ to travel with NAME OF CHILD(REN) |
| ________________________________ to ____________________________ from NAME(S) OF ADULT TRAVEL COMPANION(S) COUNTRY/COUNTRIES |
| ________________________________ to ____________________________ . DATE DATE |
|
___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ |
| Signed_____________________________________________________________ PARENT'S NAME |
| Telephone/Contact:__________________________________________________ |
| Address: |
| ___________________________________________________________________ |
| ___________________________________________________________________ |
| ___________________________________________________________________ |
| Signature of Notary:__________________________________________________ |
| Notary's Printed Name: ____________________________________________ |
| Notary Seal: |