7th NATIONAL SCOUT VENTURE CAMP

BSP Scout Camp Danao, Malapuc Norte, Maasin City

25-30 September 2016
Theme: Growth and Stability
APPLICAT ION FORM
Please complete a ll parts of the application form in block letters

Name of Local Council

__

Region _______________________________

PERSONA L DETAILS
Surname

_____

Gender
Height

First name

_______

____ Middle Initial

Date of Birth ___/ ___ / _____ (dd/mm/yy) Place of Birth

_

We ight _____ Blood type ____ N ationalit y

Fathe rs Name
School or profession
Home Address
T e l No .

___

___

_________

_______
_______

Religion

Mothe rs Nam e ________________

_______

Gra de o r le ve l of e ducation

_______

City/Province _____________

Mobile No.

Fax No.

_______
__

___

_______

______

__

______

___
Zip

E-mail _______

______

_______

Spe cial Skills/Qualif ications: _______________________________________________________________________

I transmit he re with: P 500.00 as Fu ll Payment of my R egistration Fe e ( Scout/Adult Le ade r)

Applicants Signature
Date

__/

_______
/

__(dd/m m/yy)

PARENTS/GUARDIAN C ON SENT
(for application of minor age)
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 accou nt of any incident or
injury or damage t o personal property that may occur beyond the control of the Cont ingent Officials/BSP provided ad equate safety
measures and precaution s have been instituted in participati on in the 7th National Scout Venture Camp.

_ ______ ______ _____ _____ __ ____ _____ ___ __ ___

Signature over Printed Name of Parent/Guardian
Date: _____ _____ _____ ______ _
______

LOCAL COUNCIL ENDORSEMENT:

Name of Local Council:

_______

Name of Pe rson Authorizing this Applicat ion:

_______

Signature of Pe rson Authorizing this Application:

____

Position

_______

Date __

--------------- ----------------- ---------------- ---------------- ---------------- ---------------- ---------------- ----------------- -----------

HEALTH DETAILS
Name: ___________________________________________ Lo cal Council: _________________________________
Spe cial Health Problem (Do you have any illness of the following?)
Heart disease

H ay f e v e r

Diabetic

Hypertension

Fainting

Haemophilia

Asthma

Epileptic

Sleep Walking

Autism

Any other Allergies

_____ __ _

Any physical disability

_____ __ _

Others (please specify)

_____ __ _

Recommendation and/or restr ictions (if none, so state) : ___ _______ ______ _____ _____ ______ _____ _____ ______ ___ _______ ___
Physician (Signature over Printed Nam e):__ _____ ____ _______ ______ _____ _____ ____ License No. : _____ ____ _______ ___
--------------- ----------------- ---------------- ---------------- ---------------- ---------------- ---------------- ----------------- -----------

7th NATIONAL SCOUT VENTURE CAMP

BSP Camp Danao, Malapuc Norte, Maasin City
25 - 30 September 2016
Theme: Growth and Stability

OUTFIT ROSTER OF PARTICIPANTS

Sponsoring Institution: _________________________________________________________
Local Council: ____________________________________________ Region: _____________
POSITION

COMPLETE NAME
(please write in PRINT)

AGE

GENDER

Current
Rank

Position
in the Unit

COMPLETE NAME
(please write in PRINT)

AGE

GENDER

Current
Rank

Position
in the Unit

COMPLETE NAME
(please write in PRINT)

AGE

GENDER

Current
Rank

Position
in the Unit

COMPLETE NAME
(please write in PRINT)

AGE

GENDER

Current
Rank

Position
in the Unit

Adult Leader:
Senior Scout
Senior Scout
Senior Scout
Senior Scout
Senior Scout
Senior Scout
Senior Scout
Senior Scout
POSITION

Adult Leader:
Senior Scout
Senior Scout
Senior Scout
Senior Scout
Senior Scout
Senior Scout
Senior Scout
Senior Scout
POSITION

Adult Leader:
Senior Scout
Senior Scout
Senior Scout
Senior Scout
Senior Scout
Senior Scout
Senior Scout
Senior Scout
POSITION

Adult Leader:
Senior Scout
Senior Scout
Senior Scout
Senior Scout
Senior Scout
Senior Scout
Senior Scout
Senior Scout
Prepared and Submitted by:

_______________________________
Unit Scouting Coordinator

Date: ________________________

_______________________________________
Institutional Head/Representative

Verified and Checked:

_______________________________
Council Scout Executive/OIC

Date: ______________________
_______________________________________
Delegation/Contingent Head

Scout Venture Registration Status:

Full Payment: _______ OR NO: _______________ Date: ______________
Sub-Camp Assignment: _______________________

Sub-Camp Director: _____________________