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Get and Sign Minor Child Consent to Travel Form
AUTHORIZE the above named person to make medical treatment decisions for the minor child listed above if needed. If not we have provided Emergency Contact Information below Name Address City / State / Zip Home Phone Work Phone Alternate Name Phone Signature Signature Of Non-Traveling Birth Parent s To Be Signed In Front Of A Notary Public Only 5th 2012 Subscribed and sworn to before me this day of 200 Fairfax VA Notary Public in and for the County of And the State Of....
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