I know that some people have been looking for this and I hope this helps you. Just cut and paste it in a word doc.
AFFIDAVIT OF PARENTAL CONSENT
For Travel outside the United States of a Minor Child
I, _____________________________, of said minor child, do hereby authorize__________________, of said minor child_______________, age ____ to travel to the following countries;_________________,__________________. From ___/___/___ thru ___/___/___.
(Signature of Non-traveling birth parent * To be signed in front of a notary public only)
Subscribed and sworn to before me this _________ day of _______________, 2008
Signature of Notary Public: ____________________________________________
Notary Public in and for the Country of ___________, and the state of __________
My Commission Expires: ______________________________________________
Affix Notary Seal At The Right Side of Page