Child Authorization Letter Form
Complete this form to authorize travel or care arrangements for a child. Please provide accurate information for legal validity.
Child's Full Name
*
First Name
Last Name
Child's Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent/Guardian Full Name
*
First Name
Last Name
Relationship to Child
*
Please Select
Parent
Legal Guardian
Other
Authorized Person or Organization Name
*
Purpose of Authorization (e.g., travel, medical care)
*
Authorization Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Authorization End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Emergency Contact Name and Phone Number
*
Parent/Guardian Signature
*
Submit Authorization
Submit Authorization
Should be Empty: