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    Affidavit/Sworn Statement of Actual Care and Custody: (Signature Over Printed Name) (Signature Over Printed Name)

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    Emieleah Lorenzo Pauig
    This document is an affidavit of actual care and custody for a minor child. It states that the signee has custody of the named minor child, either due to the death of or unknown parents. It gives consent for the child to participate in school sports competitions, including division, regional, and national meets. It acknowledges that the Department of Education is not responsible for any incidents beyond their control during the competitions. The affidavit is signed and notarized.

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    © All Rights Reserved
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    Affidavit/Sworn Statement of Actual Care and Custody: (Signature Over Printed Name) (Signature Over Printed Name)

    Uploaded by

    Emieleah Lorenzo Pauig
    56 views1 page
    This document is an affidavit of actual care and custody for a minor child. It states that the signee has custody of the named minor child, either due to the death of or unknown parents. It gives consent for the child to participate in school sports competitions, including division, regional, and national meets. It acknowledges that the Department of Education is not responsible for any incidents beyond their control during the competitions. The affidavit is signed and notarized.

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    Original Title

    Sworn statement

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    This document is an affidavit of actual care and custody for a minor child. It states that the signee has custody of the named minor child, either due to the death of or unknown parents. It gives consent for the child to participate in school sports competitions, including division, regional, and national meets. It acknowledges that the Department of Education is not responsible for any incidents beyond their control during the competitions. The affidavit is signed and notarized.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    56 views1 page

    Affidavit/Sworn Statement of Actual Care and Custody: (Signature Over Printed Name) (Signature Over Printed Name)

    Uploaded by

    Emieleah Lorenzo Pauig
    This document is an affidavit of actual care and custody for a minor child. It states that the signee has custody of the named minor child, either due to the death of or unknown parents. It gives consent for the child to participate in school sports competitions, including division, regional, and national meets. It acknowledges that the Department of Education is not responsible for any incidents beyond their control during the competitions. The affidavit is signed and notarized.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    Revised as of September 26, 2019

    Republic of the Philippines


    DEPARTMENT OF EDUCATION
    Regional Office ___
    Schools Division of _________

    AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE AND CUSTODY

    I _______________________, resident of ___________________, of legal age, Filipino state


    that:

    1. I have the actual care and custody of minor child _____________________, who is
    my_____________ (filial relationship to the child, if any).

    2. I further state that the actual care and custody was vested upon me since
    ______________ because

    ______ both parents of the minor child died;


    ______ the known parent died; (Proof - Death Certificate)
    ______ both parents are unknown. (Proof – Certificate of Foundling)
    ______ other scenario in cases one or both parent cannot sign the necessary
    Parental Consent form;
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________

    3. As the actual caretaker and custodian of the minor child, I hereby willingly and
    voluntarily give consent to the participation of the minor child in the school
    sports athletic meets which includes, but not limited to Division Meet, Regional
    Meet and Palarong Pambansa.

    4. I have considered the benefits that the minor child will derive from the
    participation in these activities provided that due care and precaution shall be
    observed to ensure the comfort and safety of the minor child.

    5. I hereby acknowledge that Department of Education, its management,


    personnel, employees and agent may not be held responsible for any untoward
    incident which is beyond their control.

    IN WITNESS THEREOF, I have hereto affixed my signature this ________________ in


    _______________________.

    _____________________________
    Printed Name over Signature
    Verified:

    _____________________________ _____________________________
    Adviser School Head/Registrar
    (Signature Over Printed Name) (Signature Over Printed Name)

    SUBSCRIBED AND SWORN to me this ______________________ by


    ____________________ in _________________________ who I have identified through his/her
    competent proof of identification.

    _____________________________
    NOTARY PUBLIC

    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

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