Child Passport Form - Canada
Child General Passport Application
for Canadians under 16 years of age applying in Canada or from the USA
Protected B when completed
Warning—Any false or misleading statement with respect to this application and any supporting document, including the concealment
of any material fact, may result in the refusal to issue a passport, the revocation of a currently valid passport, or the refusal of passport
services, and may be grounds for criminal prosecution. Your application will not be processed if you fail to complete all of the required
sections of this form and/or refuse to consent to the exchange or disclosure of any personal information required for the delivery of
passport services.
Type or print in CAPITAL LETTERS using black or dark blue ink.
Child's Personal Information (see Instructions, section I)
1
Surname (last name)
Given name(s)
Surname (last name) at birth
Former surname (last name)
Date of birth
Year Month Day
Place of birth
City Country Prov./Terr./State(if applicable)
Sex
Female
Male
Eye colour Current hair colour Height
(cm/in)
Weight
(kg/lbs)
Current home address
Number Street Apartment City Province/Territory/State Postal/ZIP code
Mailing address (if different from above)
Number Street Apartment City Province/Territory/State
Postal/ZIP code
Children 11 years of age or over must sign in this signature box.
Note: At no time should a person other than the child sign in this
signature box, without exception.
Date
Year Month Day
Signed at
City
Province/Territory/State
Sign within border
Signature of child (see Instructions, section I)
Date of travel
Unknown
Month Day
Information on Applicant (see Instructions, section J)
2
Is the child currently the subject of an adoption process or partially or fully in
the care of a provincial/territorial family services organization in Canada?
No Yes
Are there any separation agreements, court orders or legal proceedings
pertaining to custody of, mobility of, or access to the child?
No Yes
If yes, include all documents
Relationship between the applicant (parent or legal guardian) and the other parent or legal guardian
Date of marriage (if applicable)
Year Month Day
Applicant (parent or legal guardian)
Surname (last name) at your birth
Given name(s)
Date of birth
Year Month Day
Country of birth
Address
Telephone (daytime) Telephone (other)
Cell number (optional)
Declaration—I declare that the child named above is a Canadian citizen, that I am the
parent or legal guardian of this child and that the statements made in this application are
true. I declare that I have read and understood the Warning at the top of this page and the
Privacy Notice Statement (see section P). I consent to the collection, use and disclosure of
my personal information and that of the child by Passport Program, Citizenship and
Immigration Canada, other federal government institutions, Government of Canada offices
abroad and third party entities as outlined in the Privacy Notice Statement in the
Instructions.
Signature of applicant (also sign section 5) Date Signed at
Other parent or legal guardian
Surname (last name) at your birth
Given name(s)
Date of birth
Year Month Day
Country of birth
Address
Telephone (daytime) Telephone (other)
Cell number (optional)
Declaration—I declare that the child named above is a Canadian citizen, that I am the
parent or legal guardian of this child and that the statements made in this application are
true. I declare that I have read and understood the Warning at the top of this page and the
Privacy Notice Statement (see section P). I consent to the collection, use and disclosure of
my personal information and that of the child by Passport Program, Citizenship and
Immigration Canada, other federal government institutions, Government of Canada offices
abroad and third party entities as outlined in the Privacy Notice Statement in the
Instructions.
Signature of other parent or legal guardian
Date Signed at
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Child Passport Form - Canada PDF
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