Form 201S (Rev. 10/10) The Family Court of the State of Delaware In and For New Castle Kent Sussex County STANDBY GUARDIANSHIP AFFIDAVIT OF CONSENT OF CHILD 14 YEARS OF AGE OR OLDER Petitioner Name Street Address Respondent Name Street Address File Number P.O. Box Number City/State/Zip Code Date of Birth P.O. Box Number City/State/Zip Code Date of Birth Petition Number 2nd Petitioner (if any) Name Street Address P.O. Box Number City/State/Zip Code Date of Birth 2nd Respondent (if any) Name Street Address P.O. Box Number City/State/Zip Code Date of Birth BE IT REMEMBERED, that on this date, , ("Child"), who, 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 2) I understand that as my standby guardian(s), shall be my standby guardian(s) shall protect, manage and care for me as a parent would and they shall make decisions regarding my care upon the occurrence of my parent(s)/ guardian(s) death, incapacity, or debilitation. SWORN TO AND SUBSCRIBED before me this date, Affiant Notary Public/Clerk of Court American LegalNet, Inc. www.FormsWorkFlow.com