Father's Given Name
Father's Surname
Mother's Given Name
Mother's Surname
City of Residence Currently
*
Travel DestinationIf travelling internationally, please specify the Country. If travelling within Canada please include the City, Province.
*
First Child's Given Name
*
First Child's Surname
*
First Child's Birth Datemm/dd/yyyy
... *
Second Child's Given NameOptional
Second Child's SurnameOptional
Second Child's Birth DateOptional
...
Third Child's Given NameOptional
Third Child's SurnameOptional
Third Child's Birth DateOptional
...
Name of Person who will be taking care of child while travelling
*
Relationship to Child
*
Departure Datemm/dd/yyyy
... *
Return Datemm/dd/yyyy
... *
Email Address
*
FeedbackPlease enter any special notes or feedback you may have.
____________ ____________ and I ____________ ____________ , of ____________ , in the Province of British Columbia DO SOLEMNLY DECLARE:
I/We am/are the father/mother/parents of
I/We have sole/joint legal custody of the children.
The photograph(s) annexed as exhibit "A" are true likenesses of the children.
The children are traveling with their ____________ , ____________ , with my/our full knowledge and consent, for the purposes of a trip from ____________ , British Columbia in the Country of Canada to ____________ . Commencing on or about the ____________ and ending on or about the ____________ .
I/We appoint ____________ as the children's guardian for the purposes of consenting to emergency medical procedures, during the trip.
AND I/We make this solemn declaration, conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath
DECLARED BEFORE ME at the
)
township of Langley, in the province
)
of British Columbia, this _________
)
day of _______________, _______
)
_______________________
)
)
_______________________
A Commissioner for taking Affidavits
)
within British Columbia
)
