Form 201P Rev 2/17 The Family Court of the State of Delaware In and For New Castle County Kent County Sussex County PERMANENT GUARDIANSHIP AFFIDAVIT OF CONSENT OF CHILD 14 YEARS OF AGE OR OLDER Petitioner Name Street Address (including Apt) Respondent Name Street Address (including Apt) File Number P.O. Box Number City/State/Zip Code P.O. Box Number City/State/Zip Code Petition Number Date of Birth Date of Birth 2nd Petitioner (if any) Name Street Address (including Apt) P.O. Box Number City/State/Zip Code Date of Birth 2nd Respondent (if any) Name Street Address (including Apt) P.O. Box Number City/State/Zip Code Date of Birth BE IT REMEMBERED, that , ("Child"), on this date being duly sworn by me according to the law, personally appeared before me, a Notary Public for the State and County declared above, did depose and say: 1) I hereby agree that the above named Petitioner(s) shall be my guardian(s). 2) I understand that as my permanent guardian(s), the Petitioner(s) shall protect, manage and care for me as a parent would and that they shall make decisions regarding my care. SWORN TO AND SUBSCRIBED before me this date, Affiant Notary Public/Clerk of Court American LegalNet, Inc. www.FormsWorkFlow.com