Scribd
Upload
77 views

SWORN STATEMENT OF ACTUAL CARE AND CUSTODY Revised

1. The document is an affidavit providing consent for a minor child to participate in school sports competitions including division, regional, and national meets. 2. It states that the affiant has actual care and custody of the minor child as their relative since the child's parents are deceased or unknown. 3. The affiant acknowledges risks but believes the child will benefit, and releases the Department of Education from responsibility for accidents beyond their control.

Uploaded by

Bany Macalintal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
77 views

SWORN STATEMENT OF ACTUAL CARE AND CUSTODY Revised

1. The document is an affidavit providing consent for a minor child to participate in school sports competitions including division, regional, and national meets. 2. It states that the affiant has actual care and custody of the minor child as their relative since the child's parents are deceased or unknown. 3. The affiant acknowledges risks but believes the child will benefit, and releases the Department of Education from responsibility for accidents beyond their control.

Uploaded by

Bany Macalintal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 1

Revised as of September 26, 2019

Republic of the Philippines


DEPARTMENT OF EDUCATION
Reginal Office IV-A CALABARZON
Schools Division of BATANGAS

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)

I hereby certify true and correct to the best of my knowledge this ______________________ by
____________________ in _________________________ who I have identified through his/her competent
proof of identification.

_____________________________
NAME AND SIGNATURE OF BARANGAY CAPTAIN

DATE:__________________________________

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

You might also like