Republic of the Philippines

Department of Education
Region Six
Division of Capiz
Majanlud Elementary School

YOUTH FOR ENVIRONMENT IN SCHOOLS ORGANIZATION (YES-O)

SCHOOL YEAR 2015-2016
1 X 1 ID
MEMBERSHIP FORM
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GENERAL INFORMATION
Last Name First Name M.I. Nickname

Home Address

Contact Number/s Email Address

Citizenship Age Date of Birth Place of Birth

Father’s Name Contact Number

Mother’s Name Contact Number

EDUCATIONAL LEVEL
Grade/Year Level Section Class Adviser

Membership in Other Organization Position Hold Year

Other Co-Curricular Activities

Available Time Schedule for YES-O

Special Skills/Talents

PARENT’S/GUARDIAN’S PERMIT
I/We hereby permit my/our son/daughter to join the Youth for Environment in Schools
Organization (YES-O). We also promise to support his/her financially or otherwise in all undertakings
related to the organization’s mandated programs, projects and activities.

Parent/Guardian
(Signature Over Printed Name)
(Do not fill-up below this line)
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(To be filled-up by the YES-O Adviser ONLY)

Recommending Approval: Approved:

LUZ P. REYES FREDDIE R. RIOS

YES-O Adviser School Head
(Signature Over Printed Name) (Signature Over Printed Name)