http://www.voyage.gc.ca/main/before/consent_letter-en.asp
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’s full name: _____________________________________
Date of birth (DD/MM/YY): _____________________________
Place of birth: ________________________________________
Canadian passport number:_____________________________
Date of issuance of Canadian passport (DD/MM/YY): ________
Place of issuance of Canadian passport: __________________
________________ (child’s full name), has my (our) consent to travel with
Full name of accompanying person: _______________________
Canadian or foreign passport number: _____________________
Date of issuance of passport (DD/MM/YY):_________________
Place of issuance of passport: ___________________________
to visit ______________ (name of foreign country) 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 foreign country) at the following address:
Number/street address and apartment number: ______________
City, province/state, country: _____________________________
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)