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    SWORN STATEMENT OF ACTUAL CARE AND CUSTODY Revised

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    aljun bade
    Noel Borreros, the grandfather and legal guardian of John Rex B. Delos Santos, signed an affidavit affirming his actual care and custody of the minor child. As legal guardian, he consents to John Rex participating in school sports competitions including division, regional, and national meets. Borreros acknowledges that the Department of Education cannot be held responsible for any accidents beyond their control during the sporting events. The affidavit was signed, verified, and notarized on March 14, 2023 in Roxas City, Capiz.

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    SWORN STATEMENT OF ACTUAL CARE AND CUSTODY Revised

    Uploaded by

    aljun bade
    50 views1 page
    Noel Borreros, the grandfather and legal guardian of John Rex B. Delos Santos, signed an affidavit affirming his actual care and custody of the minor child. As legal guardian, he consents to John Rex participating in school sports competitions including division, regional, and national meets. Borreros acknowledges that the Department of Education cannot be held responsible for any accidents beyond their control during the sporting events. The affidavit was signed, verified, and notarized on March 14, 2023 in Roxas City, Capiz.

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    SWORN-STATEMENT-OF-ACTUAL-CARE-AND-CUSTODY-Revised (1)

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    Noel Borreros, the grandfather and legal guardian of John Rex B. Delos Santos, signed an affidavit affirming his actual care and custody of the minor child. As legal guardian, he consents to John Rex participating in school sports competitions including division, regional, and national meets. Borreros acknowledges that the Department of Education cannot be held responsible for any accidents beyond their control during the sporting events. The affidavit was signed, verified, and notarized on March 14, 2023 in Roxas City, Capiz.

    Copyright:

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

    SWORN STATEMENT OF ACTUAL CARE AND CUSTODY Revised

    Uploaded by

    aljun bade
    Noel Borreros, the grandfather and legal guardian of John Rex B. Delos Santos, signed an affidavit affirming his actual care and custody of the minor child. As legal guardian, he consents to John Rex participating in school sports competitions including division, regional, and national meets. Borreros acknowledges that the Department of Education cannot be held responsible for any accidents beyond their control during the sporting events. The affidavit was signed, verified, and notarized on March 14, 2023 in Roxas City, Capiz.

    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 VI
    Schools Division of Roxas City

    AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE AND CUSTODY

    I NOEL BORREROS, resident of Rizal St., Roxas City, of legal age, Filipino state that:

    1. I have the actual care and custody of minor child JOHN REX B. DELOS SANTOS, who
    is my grandchild (filial relationship to the child, if any).

    2. I further state that the actual care and custody was vested upon me since August 22,
    2023 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 14th day of March, 2023 in
    Roxas City, Capiz.

    NOEL BORREROS
    Printed Name over Signature
    Verified:

    SALLY V. BORDA MARIA THERESA D. APOSIN


    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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