Parental Consent Form – Letter of Consent to Travel To Whom It May Concern: We (I), the undersigned lawful custodial parent(s)/guardian(s) of ___________________________________,

give our (my) permission for our (my) child, less than 18 years of age, to travel without a parent to Cleveland,

OH, USA.

Child’s full name: _______________________________________________________________

Date of birth: ___________________________ Place of birth: ______________________________________

United States passport number: ___________________________ Date of issuance: _________________

ITINERARY: (List specific travel information.)

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

________________________________ (child’s full name) will be attending a Lithuanian Scouts Association

weekend event in Cleveland, OH during the period of October 6 through October 9, 2017. During that period,

he/she will be residing at (name of hotel or private residence) _________________________, at the following

address:

Street Address _________________________________________________________

City, Province, Postal Code _______________________________________________

Telephone (XXX-XXX-XXXX) ___________________________________________

Full name of accompanying adult while traveling: ___________________________________

Contact Phone Number of Accompanying Adult: ____________________________________

Address: _______________________________________________________________

_______________________________________________________________

Any questions regarding this consent letter can be directed to the undersigned (parent(s)/guardian(s)) at:

Number/street address and apartment number: _________________________________________

City, state, country: ______________________________________________________________

Telephone and fax numbers (work and residence): ______________________________________

Parent #1(printed name): _______________________ Signature: ________________________________

Relationship to Minor Passenger: _____________________ Date: _________________

Parent #2 (printed name): _______________________ Signature: ________________________________

Relationship to Minor Passenger: _____________________ Date: _________________