Consent To Travel Intake Form- enter the information below and submit the form. After you've completed the form but before clicking submit, you may want to print the form out.
Name: Address: Phone:
, born the day of , , , born the day of , , , born the day of , ,
Travel Destination: Who will accompany the children? This (or these) person(s) will have your permission to authorize and sign for emergency medical treatment for our above named children, if it is required. The dates for travel are from the day of , to the day of ,