International Travel Consent for a Minor with Affidavit and Authorization for Minor to Receive Medical Treatment - Patient Consent

For a minor under the age of 18 to travel out of the United States without both parents or legal guardians, a notarized affidavit should 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. This form should be completed and then signed in front of a Notary Public. You must carry this notarized affidavit with you. It is recommended that you also carry birth certificates or any other supporting documents.

This form also grants the adult with temporary custody of the minor the right to seek medical treatment for the minor during the trip.