I of – declare that I as the legal parent / guardian of
- GENDER OF TRAVELR :
- CHILD DATE OF BIRTH :
- PASSPORT Number :
- EXPRIING ON DATE:
My child – has my consent to travel to – INCLUDING COUNTRIES with ARKanum Adventures and Its Affiliates, from and returning to the United States around , under the Supervision of , carrying Passport # .
Any questions regarding this document, my be addressed to me at:
PARENT MAILING ADDRESS – LINE 1 :
PARENT MAILING ADDRESS – LINE 2 :
City :
State :
Zip Code :
Primary Phone :
Secondary Phone :
Parent / Guardian Signature :
Signed and Agreed to on this date: