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IN WITNESS WHEREOF AND BY SIGNING BELOW, I APPROVE TRAVEL FOR MY CHILD AS FOLLOWS: NAME (Child(ren)’s Name) AGED (Child(ren)’s Age) TRAVELING TO (Destination or Type of Travel) FROM TO (Departure Date) (Return Date) WITH (Traveling Adult’s Full Name) I ALSO AUTHORIZE THE TRAVELING ADULT TO OBTAIN ANY NECESSARY MEDICAL TREATMENT BY A LICENSED PHYSICIAN/ HOSPITAL/PHARMACY/ RESCUE SQUAD/ AMBULANCE COMPANY / MEDICAL AIR EVACUATION COMPANY..
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