Out-of-State Guardianship Consent Letter

Date:

To Whom It May Concern,

I, , am the parent/legal guardian of , born on .

I hereby grant permission for my child named above to travel/temporarily reside with in the state of from to .

During this period, I authorize to act as the temporary guardian for my child and make any necessary decisions regarding their health, education, and general welfare.

Child's Information

Full Name:

Date of Birth:

Passport/ID Number:

Temporary Guardian's Information

Full Name:

Relationship to Child:

Contact Number:

Address:

Parent/Legal Guardian Signature:

Name:

Date:

Temporary Guardian Signature:

Name:

Date:

Notary Public:

Commission Number:

My Commission Expires:

Seal/Stamp: