DS-3053 statement of consent form: Free PDF template

Key takeaways

The DS-3053 is the State Department form a legal parent or guardian uses to consent to a child’s passport without attending in person.

The non-appearing parent completes sections 1 to 3, then swears section 4 in front of a passport authorizing officer or notary.

There is no section 5, because the notarization block sits inside section 4 alongside the affiant’s signature and identification details.

Signed consent lasts 90 days, so file Form DS-11 inside that window or swear a fresh one.

Practice management software like Pabau sends, captures and stores signed consents against the client record, so your team sees what is outstanding.

The DS-3053 statement of consent form lets a child get a US passport when one legal parent cannot attend the appointment. Both parents normally have to show up in person for a child under 16. This form carries the absent parent’s written consent instead.

One detail decides most of these applications. Consent expires 90 days after the officer or notary signs it. Sign too early, or sign before you reach the notary, and the form goes back in the printer.

Below is the current edition, section by section, plus the situations that call for different paperwork.

What is the DS-3053 statement of consent form?

The DS-3053 is the US Department of State form that carries a parent’s consent to a child’s passport. You use it when that parent cannot attend the appointment.

The current edition is titled “Statement of Consent: U.S. Passport Issuance to a Child”, and the footer reads DS-3053 10-2024.

Why does written consent matter at all? Both legal parents or guardians normally have to appear in person with a child under 16. That two-parent rule comes from section 236 of Public Law 106-113. When one of them cannot be there, this form stands in for them.

The form calls the person who signs it the affiant, and that word runs through the instructions. It simply means the parent or guardian swearing the statement rather than standing at the counter.

• An official government form issued by the Bureau of Consular Affairs
• Used mainly for children under 16, and sometimes requested for children aged 16 or 17
• Sworn in front of a passport authorizing officer or a notary public
• Submitted alongside the child’s passport application, Form DS-11
• Valid for 90 days from the date the officer or notary signs it

A separate notarized statement carrying all the same details works too. Most families still prefer the printed form, because it prompts for every detail the acceptance facility expects.

When your child’s passport application needs this form

You need a DS-3053 whenever a legal parent or guardian will not be at the counter.

Five situations cover almost every case:

• One parent cannot attend. Both parents share legal custody, but only one can make the appointment, so the other swears the form and sends it along.
• Neither parent can attend. Both complete a form and name the same third party in section 2, which lets that adult file for the child.
• The parents are divorced or separated. Whoever attends brings the child. The other swears the form, whatever the custody order says about day-to-day care.
• A legal guardian is applying. A court-appointed guardian can attend in place of a parent, and any legal parent who stays away still consents on the form.
• The child is 16 or 17. One parent’s awareness is usually enough at this age, though the authorizing officer can still ask for written consent. Section 1 has a checkbox for it.

Take a common case. Two parents share custody, the father works offshore, and the mother books the appointment for their nine-year-old.

He completes sections 1 to 3, swears section 4 in front of a notary on the Tuesday, and couriers the original home. She files it with the DS-11 that Friday, well inside the 90 days.

Consent may not be needed at all when one parent holds sole authority and can evidence it. That evidence comes up further down, under absent and deceased parents.

Only the non-appearing parent can sign it

The signature has to come from the legal parent or guardian who is not attending. Nobody else will do, and a form signed by the wrong person gets refused at the counter.

• A biological or adoptive parent. The parent named on the child’s birth certificate or adoption order, who is not attending in person.
• A court-appointed legal guardian. A grandparent, relative or other guardian may sign once they produce the court order that granted guardianship.
• An institution holding guardianship. It submits a certified court order, a signed authorization on its own letterhead, and the photo ID of the employee it names.
• Nobody by proxy. An attorney, a relative or a friend cannot sign for the parent. The affiant signs personally, in front of the officer or notary.

Naming a third party in section 2 is a different matter. That adult files the application, while consent still comes from the legal parents or guardians.

If they are also looking after the child while you travel, a separate babysitter consent form covers medical treatment.

Notarization is the step that trips people up

Section 4 has to be sworn in front of a passport authorizing officer or a notary public. No seal, no consent. Work through the appointment in this order:

1. Find an officer or notary who is not related to you. The form rules out relatives of the affiant. Courthouses, banks, shipping stores and law offices all keep commissioned notaries.
2. Fill in sections 1 to 3, then stop. The form says so in bold. Signing early voids the notarization and sends you back to a fresh printout.
3. Bring photo identification and a photocopy of it. The officer records the document type, number, place of issue and dates. A copy of the front and back then travels with the form.
4. Consider remote online notarization. Many states allow notarization over a secure video call, where you upload the form and your ID, then sign on camera.
5. Check that your acceptance facility takes it. Call before booking an online session. Rules on electronic seals and wet signatures vary, and confirming costs one phone call.
6. Watch the 90-day clock. Consent expires 90 days after the officer or notary signs. Miss that window, and the affiant swears a new one.

Notarizing abroad works differently. Some countries will not accept a local notary for this form, so the affiant visits a US embassy or consulate instead.

How to complete the DS-3053, section by section

The current edition runs to four sections on one signing page. The non-appearing parent drafts the first three at home, and the fourth waits for the appointment.

That split is worth getting straight before you print, so here it is at a glance.

1. Section 1, the child. Print the child’s name as last, first and middle, then the birthdate as month, day and year. Copy the spelling straight from Form DS-11. A checkbox sits beside it for a child aged 16 or 17.
2. Section 2, the applying adult. Name the adult who will stand at the counter, then check their relationship: legal parent, legal guardian or third party. The third-party option is what lets a trusted adult file on the parents’ behalf.
3. Section 3, the statement of consent. Print the full name of each legal parent or guardian who cannot appear. Two numbered slots follow, each with an address, city, phone and email block. The second block has a “same as 1” checkbox.
4. Section 3, the optional restriction line. Leaving it blank consents to both a passport book and a card. Writing “issue passport book only” or “issue passport card only” narrows the consent to one of them.
5. Section 4, the oath. Leave this alone until the officer or notary asks you to sign. It holds the affiant’s signature and date, the identification details, and the officer or notary’s signature, date, location and seal.

The form does not ask for the child’s passport number, their country of residence, or the affiant’s date of birth. Looking for those boxes means you are reading an old version, or another form entirely.

Where to get the official form for free

The official PDF is free from the State Department, and it is the only version an acceptance facility takes. Our worksheet above is a planning aid, so draft your answers there and copy them across.

• Open the forms page at travel.state.gov. Search it for DS-3053 and follow the link it gives you.
• Or go straight to the source file. The State Department maintains eforms.state.gov/Forms/ds3053.pdf, so that copy is always the current release.
• Check the edition line before you print. The footer of the current release reads DS-3053 10-2024, with an OMB expiration date of 10-31-2027.

Print it and leave it as it comes. Do not retype the form, redraw the boxes, or drop a section you think does not apply. Use black ink only. That instruction sits at the top of the signing page, next to the warning about correcting a mistake on the page.

What to do when the other parent is absent or deceased

Difficult family situations need different paperwork, not a stalled application. In several of them the DS-3053 is not the document the facility wants at all.

Contested custody and international abduction concerns are worth an attorney’s time before you apply. States differ on what a facility accepts as evidence of sole authority, so check locally rather than assume.

Run this check before you submit

Most rejections come down to the same handful of avoidable errors. Walk this list on the morning of the appointment:

• Sections 1 to 3 filled in, section 4 blank. The oath has to be sworn in front of the officer or notary, so an early signature means a fresh form.
• Both dates matching. The affiant’s date and the officer or notary’s date fall on the same day.
• An unrelated officer or notary. The form excludes relatives, and a relative’s seal invalidates the consent.
• The identification photocopy attached. That means the front and back of the document recorded in section 4.
• A clean page, with no corrections. Crossings out and correction fluid are not accepted, so reprint and start that section again.
• The original, not a photocopy. The acceptance facility needs the signed and sealed form, filed with the child’s DS-11.
• Child details matching Form DS-11. A missing middle name or a nickname is enough of a discrepancy to hold up the application.

The 90-day clock deserves its own line here. It starts when the officer or notary signs, not when the appointment is booked. A consent sworn in January will not survive a May filing.

How the DS-3053 differs from other minor consent forms

Several documents authorize something on a child’s behalf, and mixing them up delays passports, trips and treatment.

A medical consent form covers treatment while a parent is away, for instance, and it carries no weight at a passport counter.

The line worth remembering is a narrow one. The DS-3053 exists for passport issuance and no other purpose. A travel consent letter will not stand in for it, and neither will one of the medical forms your doctor’s office keeps on file.

How Pabau keeps signed consent forms tracked and stored

A passport consent is a family matter, but the version-control problem behind it will look familiar to any practice. Forms go out as email attachments or printouts and come back signed on paper. They then sit in a drawer or an inbox until somebody needs them.

Practice management software like Pabau closes that loop. You build the consent or intake form once, send it to the right person before their appointment, and collect the signature digitally. Everyone works from the current version, because there is only one.

Each signed document then files itself against the client record with a timestamp. Your team can see at a glance who has signed and who has not. Chasing an outstanding form becomes an automated reminder rather than a phone call, and an audit stops being a filing-cabinet exercise.

Running paperless patient intake this way also keeps the right form attached to the right context, which is where most compliance errors start.

Collect and store every signed consent in one place

Pabau’s digital forms send the current version of a consent to the right person, capture the signature, and file it against their record automatically. Your team can see what has been signed without opening a filing cabinet.

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Conclusion

The DS-3053 rewards preparation and punishes improvisation. Draft your answers first, then take photo identification and a photocopy of it to the appointment. Leave section 4 untouched until the officer or notary asks for your signature.

The timing is what usually costs families a second appointment. Swearing the consent early feels organized, but it can expire before the appointment comes around. Work backward from the DS-11 filing date, not from whenever the absent parent happens to be free.

If your practice handles consent forms of its own, the same discipline applies at a larger scale. Book a demo to see how Pabau sends, signs and stores every consent against the right client record.

Continue your research

Need consent for treatment rather than travel? Medical consent form for minors covers who may authorize care, the treatments allowed, and how long the authority lasts.

Treating a child whose parent is not in the room? Consent to treat a minor form records the guardian’s authority and the emergency contacts a practice needs on file.

Sending a child’s records to another provider? Medical release form for a minor sets out what may be shared, with whom, and for how long.

Releasing confidential information on request? Authorization for release of confidential information covers the purpose of disclosure, the recipient, and the expiration date.

Need a signature that satisfies HIPAA? HIPAA authorization form template shows the elements a valid authorization has to contain.

Frequently asked questions