BOY SCOUTS OF THE PHILIPPINES

EASTERN VISAYAS REGION

REGIONAL SCOUT VENTURE CAMP

26-30 December 2022
Capitol Hills Scout Camp, Cebu City

APPLICATION FORM FOR PARTICIPANTS

Local Council: __________________________

PERSONAL DETAILS

Name: ___________________________________________________________________
Last Name Given Name Middle Name
Sex: _______ Date of Birth: __________________ Place of Birth: ____________________
Height: ____ Weight: _____ Blood type: ______ Nationality: ________ Religion: _________
Father’s Name: ______________________ Mother’s Name: ______________________
School or profession: _____________________ Grade or level of education: ____________
Home address: _____________________ City address: ____________________________
Tel. No: __________ Mobile No: ____________ Email: _____________________________
Special Skills/Qualifications: __________________________________________________

_______________________________________
Applicant’s Signature over Printed Name
Date: ________________

PARENT’S/GUARDIAN’S CONSENT
(for minor applicants)

We hereby approve this application and certify to its correctness. In consideration of

the benefits to be derived, we expressly waive any and all claims against the Boy Scouts of
the Philippines or its representatives on account of any incident or injury or damage to
personal property that may occur beyond the control of the Contingent Officials/BSP
provided adequate safety measures and precautions have been instituted in participation in
the Regional Scout Venture Camp.

_______________________________________
Signature over Printed Name of Parent/Guardian
Date: ________________

HEALTH DETAILS

Special Health Problem (Do you have any of the following illnesses?)
☐ Heart disease ☐ Hay fever ☐ Diabetes ☐ Hypertension ☐ Fainting
☐ Haemophillia ☐ Asthma ☐ Epilepsy ☐ Sleep Walking ☐ Autism
Any allergies: __________________________________________
Any physical disability: ___________________________________
Others: _______________________________________________
Recommendations and/or restrictions (if none, so state): ____________________________

COVID-19 Vaccination Status (Please attach copy of COVID-19 vaccination card)

☐ Fully vaccinated (w/ or w/o booster) ☐ Partially vaccinated ☐ No vaccination
Note: Participants not fully vaccinated must present negative COVID-19 antigen test result upon arrival.

Physician (signature over printed name): ________________________

License No: _________