Airlines, charter and vessel operators, camps, and venues set their own rules for minors travelling without a parent or guardian. Confirm requirements with your carrier and operator before departure. This is a practical travel document template, not legal advice.
A. Trip & Minor
Trip name
Itinerary reference
Minor's full legal name
Date of birth
Mode of travel
ID carried
Departing from
Departure date
Return date
Destination(s)
Flight itinerary
Lodging / accommodations
Charter / vessel / transport
B. Parent / Legal Guardian 1
Full legal name
Relationship to minor
Address
Mobile phone
Email
C. Parent / Legal Guardian 2
Full legal name
Relationship to minor
Address
Mobile phone
Email
D. Accompanying Adult / Trip Leader
Full legal name
Relationship / role
Mobile phone
Email
Organization / team
E. Consent & Authorization
I/we, the undersigned parent(s) or legal guardian(s) of ____________________, authorize the minor to travel within the United States to ____________________ in the company of ____________________ from __________ to __________, consistent with the itinerary described above.
I/we further authorize reasonable changes to that itinerary caused by weather, surf and swell conditions, airline or transport disruption, charter operations, safety, or emergency, provided that the accompanying adult makes reasonable efforts to contact a parent or legal guardian.
F. Emergency Medical Authorization
I/we authorize the accompanying adult / trip leader named above to consent to emergency medical and dental evaluation and treatment for the minor when a parent or legal guardian cannot be reached promptly.
Insurance carrier
Policy / member number
Insurance emergency phone
Blood type
Allergies
Medications
Relevant conditions
Dietary restrictions
Primary physician
Physician phone
Preferred hospital / instructions
Swimming ability
Surfing ability
G. Emergency Contacts
Primary contact
Phone
Secondary contact
Phone
Additional contact (not travelling)
Phone
H. Signatures
Parent / Guardian 1 signature — print name
Parent / Guardian 2 signature — print name
Witness signature (optional) —
Typed names entered online identify the signers only. They are not an electronic signature service and are not a notarization.
Notary Acknowledgment (optional)
State / Country
County / Province
On this ______ day of ______________, 20____, before me personally appeared the above-named parent(s) / legal guardian(s), known to me or satisfactorily proven to be the person(s) whose name(s) are subscribed to the foregoing instrument, and acknowledged that they executed the same for the purposes stated therein.
Notary seal / stamp
Notes / handwritten corrections
