The following sample letter can be amended to meet your specific situation and requirements.

To Whom It May Concern

I (We), _______________________________(Full name(s) of custodial and/or non-custodial parent(s)/legal guardian(s)), am (are) the (lawful custodial parent and/or non-custodial parent(s) or legal guardian (s)) of

Child full name: ___________________________________

Date of birth (DD/MM/YY):__________________________

Place of birth: ______________________________________

Passport number: ___________________________________

Date of issuance of passport (DD/MM/YY):______________

Place of issuance of passport: __________________________

____________________ (Child’s full name), has my (our) consent to travel with

Full name of accompanying person: _________________________

Passport number: ________________________________________

Date of issuance of passport (DD/MM/YY): ___________________

Place of issuance of passport: _______________________________

to visit ___________ (Canada) during the period of ________________ (dates of travel: departure and return). During that period, _____________ (child’s full name) will be residing with _________________ (name of person where child will be residing in Canada) at the following address:

Number/street address and apartment number: ___________________

City, Province: ____________________________________________

Telephone and fax numbers (work and residence): ________________

Any questions regarding this consent letter can be directed to the undersigned at:

Number/street address and apartment number: ____________________

City, province/state, country: __________________________________

Telephone and fax numbers (work and residence): _________________________

Signature(s): ________________________________________________________

Date: ________________________

(Full name(s) and signature(s) of custodial parent, and/or non-custodial parent(s) or legal guardian(s))

Signed before me, ______________ (name of witness), this ______________ (date) at ___________________ (name of location).

Signature: __________________________ (name of witness)