We, ZHANG SAN and LI SI 【父母姓名英文】are the lawful custodial parents of:
ZHANG XIAOSAN 【未成年人姓名】
Date of Birth: 09 FEB 2010 【孩子出生日期，按照护照上的写】
Place of Birth: Changde, Hunan 【出生地点】
Passport Number (if applicable): EK1039954 【护照号码】
– Country of Issuance: CHN 【护照签发国家】
– Date Issuance: 12 4APR 2023 【护照签发日期】
– Date of Expiration: 11 4APR 2028 【护照有效日期】
This summer, our child is joining inMountains School Summer Camp 2023 USA, as his/her parents, we do not have the visa to enter the country, so we authorize my child to travel with the following individuals as part of the group:
A – the Leader of our group:
– Individual Name: LUO JUN / JULIAN LUO 【罗老师的姓名】
– Relationship to Child: TEACHER OF MY CHILD【罗老师与孩子的关系】
– Passport Number: [] 【罗老师的护照号码】
– Country of Issuance: CHINA 【护照签发国家】
– Date Issuance: 29 APR 2014【护照签发日期】
– Date of Expiration: 28 APR 2024【护照有效日期】
We authorize my child to travel to the following location THE UNITED STATES OF AMERICA – CALIFORNIA TO ARKANSAS, during the period beginning on JULY 12TH, and ending on AUGUST 10TH.
Father Signature: [打印出来后，父亲在这里签名] Date: [签名日期]
Print Name: Tan XX【父亲的姓名】
Contact: 【联系方式】
Mother Signature: [打印出来后，母亲在这里签名] Date: [签名日期]
Print Name: Jiang XX 【母亲的姓名】
Contact: 【联系方式】
按照上面的提示将孩子的护照信息填写好，将父母的姓名填写好之后，将所有中文连同括号都去掉，然后打印，父母签名，放进孩子的签证资料里。
