Affidavit

I, Full Name of Parent or Guardian Giving Permission to Other Parent or Guardian, of

Address of Parent or Guardian Giving Permission to Other Parent or Guardian, being of legal
age, do hereby depose and say under oath as follows:

1. I am the biological father of Name(s) and Birthdates of Child/Children (the "Child").

2. I am married to Name of Spouse (my "Spouse") born on Date of Birth of Spouse who is
the biological father of the Child.

3. We are not separated from one another and reside together as husband and wife.

4. Attached hereto as Exhibit "A" is a true copy of the birth certificate(s) of the Child.

5. I hereby grant permission to my Spouse to travel to Destination of Travel with the Child
for the purposes of a vacation. They intend to depart on or about Date of Departure and
return to the United States of America on or about Date of Return to USA.

Witness my hand under the penalties of perjury Date of Statement (ie. July 1, 2000)

Signature Of Deponent

STATE OF STATE
COUNTY OF COUNTY

On Date of Statement (ie. July 1, 2000) before me, Full Name of Notary Taking Sworn Statement,
personally appeared Full Name of Person Making Sworn Statement, personally known to me (or proved
to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within
instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his
signature on the instrument the person executed the instrument.

WITNESS my hand and official seal.

Signature
 Exhibit "A"
True Copy of the Birth Certificate(s) of the Child

Attach True Copy(ies) of Birth Certificates of Children Here