Mark - BSP Coastal Clean-Up 2023

Republic of the Philippines
Department of Education
National Capital Region
Schools Division Office of Caloocan City
Gregoria de Jesus Elementary School
P. Sevilla Street cor. 9th Avenue, Grace Park West, Caloocan City, 1400
October 25, 2023
To: DOMITILLA S. GUTIERREZ Ph D

Principal III – Institutional Scouting Representative
Madam:
Greetings!
I would like to endorse to your good office our delegates to the 18th National Scout
Jamboree on December 11-17, 2023 at Passi City, Iloilo:
Scouts:
 Borje, Brentt Moore B. (VI – Lino Brocka)
 Gonzales, Azriel Kent Josiah (VI – Lino Brocka)
 Guevarra, James Francis N. (V – Rodrigo Duterte)
 Sapad, J-Ron Gabriel C. (V – Rodrigo Duterte)
 Sapad, Von Mark Louie C. (VI – Fernando Amorsolo)
September 14, 2023
DR. DOMITILLA S. GUTIERREZ

Principal III
Caloocan City
Madam:
I have the honor to inform your good office that the Boy Scouts of
Gregoria de Jesus Elementary School will participate in the International
Coastal Clean-Up that will be held on September 16, 2023 (Saturday) at
Tanza Marine Tree Park, Navotas City from 6:00 A.M. - 12:00 N.N.
Telephone No.: (02) 8 367-1782

Email Address: 136618@deped.gov.ph
Website: https://gregoriadejesuscal0.wixsite.com/gdjes136618
Facebook: Gregoria De Jesus Caloocan
In connection, the undersigned would like to request permission to
conduct the said activity. The purpose of the said activity is to help aspiring
scouts to continue work for their advancement and for them to identify the
fields they need to develop especially in the merit badge requirements.
It is understood that scouts and their leaders should be physically
and mentally fit, permission from parents/guardians of the scouts will be
secured, scouts are registered, and precautionary measures will be taken.
Attached herewith is the list of participants, and parental consent and
waiver.
We are looking forward to your most favorable response as regards
this matter.
Thank you very much.
Respectfully yours,
MARK GREGORY DV. BANIAGA, WBH

BSP Coordinator
Approved:
DOMITILLA S. GUTIERREZ, PhD

Principal III/Institutional Head
List of Participants
SCOUTERS
1. Sctr. Mark Gregory DV. Baniaga, WBH MAPEH Department
2. Sctr. Gemjy Nicole M. Reyes, WBH TLE Department
3. Sctr. Gaspara Lilia C. Vivas, WBH TLE Department
SCOUTS
1 Sct. Alexa Venice Titic
2 Sct. Katherine Kirsten O. Dayrit
3 Sct. Ram Adelei V. Cruz
Telephone No.: (02) 8 367-1782

4 Sct. Yuri Castil
5 Sct. Aljen Molina
6 Sct. Jan Radny B. Sampaga
7 Sct. Jhanna Nichole D. Gruella
8 Sct. Precious Iyesha Dela Pena
9 Sct. Princess Claire S. Alfaro
10 Sct. Rose Angela J. Verona
11 Sct. Juan Miguel Carag
12 Sct. Jullian Rhei M. Flores
13 Sct. Adrian Zamora
14 Sct. Uno Amiel D. Miguel
15 Sct. Princess Nicka D. Libao
16 Sct. Andrea Mercedes A. Manrique
17 Sct. Earljane F. Medallion
18 Sct. Axel Jay Bello
19 Sct. Elianah Francine A. Navarro
20 Sct. Stefanie Rhiana A. Oronce
21 Sct. Crizhalyn Kate D. Castro
22 Sct. Loren Benedict C. Erediano
23 Sct. Mark Jared Antiquena
Telephone No.: (02) 8 367-1782

APPLICATION TO ATTEND
INTERNATIONAL COASTAL CLEANUP
Parent/ Guardian’s Name:

__________________________________________________________________________________
(Surname) (First name) (Middle Initial)
Scout’s Name:
__________________________________________________________________________________
(Surname) (First name) (Middle Initial)
School: Gregoria de Jesus Elementary School District: Pobcaran
Age: ________ Date of Birth: _______________________Place of Birth: _____________
Address:
__________________________________________________________________________________
Contact number: ___________________ E-mail Address:

_________________________
Telephone No.: (02) 8 367-1782

Religion: _________________________ Hobbies: ________________________________
PARENTS PERMIT
I hereby willingly and voluntarily give consent to the participation of my child
______________________________________________________ to attend the International
Coastal Cleanup on September 16, 2023 at Tanza Marine Tree Park, Navotas
City from 7:00 A.M. - 12:00 N.N.
WAIVER
I am aware of the risk connected with attending this event on this date. I agree to
not hold accountable or bring legal action against the Caloocan High school,
council, their activity officers, unit leaders or council staff. This waiver releases the
Caloocan High School and council from all liability relating to injuries that may
occur on location before, during or after activity.
By signing this agreement, I agree to hold the council entirely free from any
liability, including financial responsibility for injuries incurred, regardless of the
reasons of circumstances.
I acknowledge the risk involved with this activity including, but not limited to,
muscle tears, sprains, and other physical injuries. I certify that my child’s
participation is voluntarily, and I have been made aware of the risk. Additionally, I
guarantee that my child does not have any conditions that may increase any
likelihood of injury.
Telephone No.: (02) 8 367-1782

My child will make every effort to obey the activity officers, and all his unit leaders,
all safety rules, and will ask for clarification if needed.
Further, I authorize the process of the personal information of my child in

accordance with the Data Privacy Act of 2012.
___________________________________________________
Parent’s /Guardian Signature over printed name
*** Photocopy of Parent’s valid ID***
Telephone No.: (02) 8 367-1782


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Republic of the Philippines

October 25, 2023

To: DOMITILLA S. GUTIERREZ Ph D

September 14, 2023

DR. DOMITILLA S. GUTIERREZ

Telephone No.: (02) 8 367-1782

MARK GREGORY DV. BANIAGA, WBH

DOMITILLA S. GUTIERREZ, PhD

Telephone No.: (02) 8 367-1782

Telephone No.: (02) 8 367-1782

Parent/ Guardian’s Name:

School: Gregoria de Jesus Elementary School District: Pobcaran

Age: Date of Birth: ___Place of Birth: _

Contact number: ___________________ E-mail Address:

Telephone No.: (02) 8 367-1782

Religion: _ Hobbies: ________

Telephone No.: (02) 8 367-1782

Further, I authorize the process of the personal information of my child in

* Photocopy of Parent’s valid ID*

Telephone No.: (02) 8 367-1782

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