Affidavit of Costudy and Care
Uploaded by
Rhea Jean T. GarciaAffidavit of Costudy and Care
Uploaded by
Rhea Jean T. GarciaRepublic of the Philippines
Department of Education
VI- WESTERN VISAYAS
AKLAN
BATAN ACADEMY (A NATIONAL SCHOOL)
AMBOLONG, BATAN, AKLAN
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
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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
6.
andFurther, I/We not
agent may authorize
be heldthe personnelfor
responsible of any
Department
untowardofincident
Education to collect,
which process,
is beyond retain,
their control.
and dispose of personal information of the above-mentioned athlete in accordance with the Data
Privacy Act of 2012.
IN WITNESS THEREOF, I have hereto affixed my signature this ________________ in
_______________________.
0
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)
)
ND CUSTODY
onship to the child, if any).
_________________
Foundling)
t sign the necessary
_________________
_________________
_________________
hletic meets which includes,
nsa.
m the participation in these
o ensure the comfort and
ment, personnel, employees
to collect,
hich process,
is beyond retain,
their control.
in accordance with the Data
_______________ in
0
nted Name over Signature
chool Head/Registrar
ture Over Printed Name)
y ____________________ in
ent proof of identification.
NOTARY PUBLIC