AFFIDAVIT OF <INSERT YOUR NAME OF PERSON STAYING IN US> Before me the undersigned authority personally appeared, <INSERT NAME>,

who by me first being duly sworn deposes and says as follows: 1. My name is <INSERT NAME>, and I have personal knowledge of all matters set

forth in this affidavit. A copy of my Florida drivers license is attached hereto as Exhibit A. 2. I am married to <INSERT NAME>. <INSERT NAME> and I have <INSERT

#>children, including <INSERT NAME> and <INSERT NAME>. 3. 4. We all reside at <INSERT ADDRESS>, Florida. On Thursday, <INSERT MONTH AND DAY>, 2013, <INSERT NAME> and

<INSERT NAME> are traveling from Florida to Canada, where <INSERT NAME> will participate in a youth hockey tournament. They are scheduled to return to Florida on <INSERT DATE>. 5. I expressly agree that my son, <INSERT NAME>, may travel outside of the

United States with his father, <INSERT NAME>, who is my husband, and thereby authorize them to do so. FURTHER AFFIANT SAYETH NAUGHT. Executed on April __, 2013.

___________________________________ <INSERT NAME>

STATE OF FLORIDA COUNTY OF <INSERT COUNTY> ) ): SS )

BEFORE ME, the undersigned authority, personally appeared <INSERT NAME>, who, being first duly sworn according to law, deposes and says that he executed the foregoing Affidavit and that the representations therein are true and correct to the best of his knowledge and belief. SWORN TO and SUBSCRIBED TO before me on this ______ day of ______________, 2013. Individual Personally Known __________ OR Individual Produced Identification __________ Type and Number of Identification Produced

_____________________________________ NOTARY PUBLIC, State of Florida at Large My Commission Expires: