APPLICATION for PARTICIPANTS Name of Institution: Name of Council: © poyscour ©) senior scour ) ADULT LEADER PERSONAL DETAILS ‘Sumame: First Name: Mi: Gender: ‘Age: Date of Birth Birth Pace: Height: Weight:____ Blood Type: Nationality: _ Religion: __ Father's Name: ‘Mother's Name: ‘School/Profession: Grade/Level of Education: Home Address: CityProvince: Mobile No: Email Address: Current Scout Rank/ Position: Unit/ Outfit No: Special Skils/Qualfications: | transmit herewith P 300.00 as Full Payment of my Registration Fee, Applicant's Signature: Date: PARENT’S/ GUARDIAN CONSENT (For the application of Minor Age) ‘We hereby approve this application and ceri tits corectness. In consideration ofthe benefits tobe derived, we expressively waive any and all claims against loio (Confesor) Council, Boy Scouts of the Philippines or its representaives on account of any incident or injury or damage to personal property that may occur beyond the contol of the Contingent Offcias/BSP provided adequate safety measures and precautions have been insttuted in partcipation tothe 18 Natonal Scout Pre-Jamboree Training. Signature over Printed Name of Parent) Guerin Date Contact Person in case of emergency/ Relatonshipi Contact No. LOCAL COUNCIL ENDORSEMENT ‘Name of School: Name of Person Authorizing this Applicaton: Signature of Person Authorizing this Application HEATLH DETAILS Heart Disease Hay Fever Diabetic Hypertension Fainting Hemophilia Asthma —— Epileptic Sleep Waking Autism Any other Allergies: ‘Any physical disability: Other (please speci) Recommendation andlor restrictions (ifnone, so stat) Licensed Physician (Signature over printed Name) Ucense Number:ROSTER of PARTICIPANTS AREA DISTRICT SCHOOL PREJAM SCHEDULE VENUE: SUMMARY ADULTIS:. SCOUTS: TSHIRTS: XS_ Ss M J. XL XXL XXL TOTAL PAX: TOTAL PCS: No. | Description ‘Complete Name (Fam.Name, Given, Mi) ‘Age | Gender Current Rank Position in the Unit Adult Leader 1. | Scout Soout g Complete Name (Fam.Name, Given, Mt) ‘Age | Gender Current Rank Position in the Unit ] |No. | Description | complete Name [ime Given, Age Gender Current Rank Position in the Unit No. | Description | complete Name aanans Given, Gender Current Rank Position in the Unit Unit Scouting Coordinator Checked/Approved by: Council Scout Executive Noted By: Institutional Head/ Representative