Online Consent Form

Fields marked with orange are required.

I/We, and (full name parent(s)/legal guardian(s)), am/are the mother/father/ parents/legal guardian(s) of: (my/our “child”)

My/our child’s date of birth: Year(YYYY)
My/our child’s place of birth:

My/Our child has my/our consent to travel with (my/our “child’s temporary guardian”) to visit (name of foreign country)
from Year(YYYY)
to Year(YYYY) (dates of departure and return).

During the time that my/our child is in my/our child’s temporary guardian’s custody, the
said temporary guardian has the authority to make any medical decisions which may be
required to be made.

Any questions regarding this consent letter can be directed to the undersigned at

(Street address/apartment number, City, Province)

Phone #'s: (W) (C) (H)

Dated at Nanaimo, B.C., this day of , Year(YYYY)

Anti-Spam Security Question:
What is 5+1 =

Online Consent Form

Related Links