CONSENT FOR INTERNATIONAL TRAVEL OF CHILD UNDER 18 YEARS OLD WITH ONLY ONE PARENT
(一方の親のみが同伴する18歳未満の子の海外渡航に対する同意書)
We, ________ and ________, declare that we are the parents of the following child:
________, gender: Male, born on the following date: ________, passport number: ________.
The above child has our consent to travel to ________ from ________ to ________ under the responsibility of his mother, ________, passport number ________.
Mother accompanying the child (子に同伴する母)
(signature; 下記に署名してください)
_____________________________
________
Date of signature (右に署名日を記入してください): ___________________
Passport number: ________
Address: ________
Phone number: ________
Father who gives consent (渡航同意を付与する父)
(signature; 下記に署名してください)
_____________________________
________
Date of signature (右に署名日を記入してください): ___________________
Address: ________
Phone number: ________
Witness (証人)
(signature; 下記に署名してください)
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