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Educational
Tours
- If parents of a minor are married, both parents must sign the form,
even if one parent is accompanying the minor
The adventure
of a lifetime
(country)
(return date)
Signature ___________________________________
Signature ___________________________________
Address ____________________________________
Address ______________________________________
___________________________________________
_____________________________________________
Date _______________________________________
Date _______________________________________
Notarization section
On ______________________ before me, the undersigned, a notary public in and for said province or territory, personally
(date)
proved to me on the basis of satisfactory evidence to be the person whose name(s) _______________ subscribed to the
(is/are)
within instrument and acknowledged that ___________________ executed the same. Witness my hand and official seal,
(he/she/they)
Signature _______________________________________________________________________________________
(notary public in and for said province or territory)
Please note: This form is not valid without notarization or without supplemental documentation required for entry into certain countries.
Revised: 1/31/2013
121412