Republic of the Philippines

Region VIII
Province of Leyte
Baybay City

AFFIDAVIT OF GUARDIANSHIP

I, __________________________, of legal age, Filipino, single/married/widow/er and

with residence and postal address at _________________________________, after being duly
sworn to in accordance with law, depose and state that:
1. I am the _____________________ (relationship) of the minor named below who will
participate in the DepEd Sports Competitions from Lower Meet up to Palarong
Pambansa in the sports of ____________________________ :

NAME OF MINOR DATE OF BIRTH AGE

_________________________________ __________________ _________

2. I am the guardian of the above-named minor;

3. The said minor is under my care and custody;
4. I am executing this affidavit to confirm and affirm the foregoing facts and to prove that
I am the legal guardian of the above-named minor, and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of

____________, 20___ at ___________________________. ___________________

AFFIANT SUBSCRIBED AND SWORN to before me in the _______________________

this ____ day of ______________, _______ by _______________________, who has
satisfactorily proven to me his/her identity through his/her ______________________________,
valid until ________________, that he/she is the same person who is personally signed before
me the foregoing Affidavit of Guardianship and acknowledged that he/she executed the same.

NOTARY PUBLIC
Doc. No. ____________;
Page No. ____________;
Book No. ____________;
Series of ____________.