The undersigned ..........................................................................................................................
Name of
parents
Address : ............................................................................................................................. (France)
Parents of : ....................................................................................................................................
Birthdate : .............................................................................
Mo/Mois. Day/Jour Yr./Année
Authorizes :...................................................................................................................................
Name of Host Family
Address : ............................................................................................................................. (USA)
To
pick up the above designated minor child at this Airport and to travel inside
and outside MICHIGAN, as outside of the USA by car, train, plane,…
Signed : ....................................................................................................
Date .................................................................. In ................................ (France)