AUTHORIZATION FOR A MINOR CHILD TO TRAVEL TO CANADA ** Complete this form in full, leaving no empty blanks. Failure to do so may result in processing delays** Child’s Information Family Name:

Given name (s):

Date of Birth:

(DD/MM/YYYY)

Complete Address: Telephone:

(country code/regional code/number)

Travel dates to Canada (DD/MM/YYYY)

From: With the purpose of:

(DD/MM/YYYY)

To:

%Tourism %Study (specify):

%Summer Camp % Visit a relative/friend

The Guardian of the child will be:

The child will be travelling with (If applicable):

Family Name:

Family Name:

Given Name (s):

Given Name (s):

Complete Address:

Complete Address:

Phone Number:

Passport Number:

Relationship:

Relationship:

(i.e. aunt, friend, summer camp counsellor, etc)

(i.e. aunt, friend, teacher, etc.)

Status in Canada: (i.e. Canadian citizen, permanent resident, temporary resident (tourist, student, worker)

Signatures of BOTH parents or of Legal Guardian FATHER

MOTHER

Family Name:

Family Name:

Given Name (s):

Given Name (s):

Complete Address:

Complete Address:

Phone Number:

Phone Number:

Signature:

Signature:

Date:

(DD/MM/YYYY)

Date:

Signature of BOTH parents is MANDATORY, unless one of the following documents is provided Divorce decree clearly stating the loss of parental authority of one of the child’s parents Death certificate if one of the child’s parents is deceased

(DD/MM/YYYY)