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 350.00 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. : _____ ____ _______ ___
--------------- ----------------- ---------------- ---------------- ---------------- ---------------- ---------------- ----------------- -----------

th

7 NATIONAL SCOUT VENTURE CAMP

BSP C amp D anao, Malapuc N orte, Maasin City
25 30 September 2016

APPLICATION FORM FOR THE NATIONAL SERVICE TEAM

Please complete a ll parts of the application form in block letters

Position in Scouting __________________________

Surname
Gender

_____
_________

Fi rst name

__________________________

Level of Ed ucati on _________________________________ Nati onali ty

Home Address
Tel No.

____ Mi ddl e Ini ti al ______________

Date of Bi rth ___/ ___ /______ (dd/mm/yy) Professi on _________

_________________

_______ _____ Mobil e No.

_______

Ci ty/Provi nce ______

________ ___________ Fax No.

__

__

______________________

Rel i gion

______________________

_________Co untry ___________________ Zi p _______

__________________ E-mai l ______________________

Hei ght _______________________________ (cm) W ei ght _______________________________ (kg ) Bl ood Type ________________________
Language Skill s: ( Please indic ate a fluency lev el)
1. _______________________________________________________ Speci fy ________________________________________________________
2. _______________________________________________________ Speci fy ________________________________________________________
3. _______________________________________________________ Speci fy ________________________________________________________
Special Foods (Do you have any speci al requirements for medi cal , religious o r other reasons?)
Speci al foods requi red:

______________________________________

Food you mus t no t eat (Pl eas e sp eci fy):

___________________

Due to (al l ergy, speci al di et, etc):

______
_____________

__________________________

______

Scouting Histo ry (please com plete):

Present Posi ti on wi thi n the Scout Org ani zati on:

_____________________

Parti ci pati on i n NATIONAL events as:

_____________________

Please give u s more info rmation about your knowl edge, experiences:
Peace Ed ucati on

Handi crafts

Pi oneeri ng

Computer

Warehous es/Stoc kroom

Admi ni strati on

Photog rap hy

Li feguard

Human Ri ght

Canoei ng/Rowi ng

Ori enteeri ng

Snorkel li ng

Rapp el li ng

Run Group Ac ti vi ti es

Rel i gi ous Acti vi ti es

Publ i c Rel ati on

Journal i sm

Radi o Operator

Outdoor A cti vi ti es

Crowd Manag ement

Performi ng A rts

Fi rst Ai d

Hi ki ng

Musi c (Pl ay Instrument)

Bi ki ng

Heal th Educ ati on

Envi ronment

Nature Study

Exhi bi ti on Operati ng

Securi ty

Rock Cl i mbi ng

Swi mmi ng

Roboti c

Skill/Qualification s: ___________________________________________________________________________________________
I transmit herewith: P 350.00 as ful l payment of my Regi strati on Fee
Applicants Signature ________________________________

Date

(dd/mm/yy)

LOCAL COUNCIL ENDORSEMENT:

Name of Loc al Council:

_______

Name of Person Authorizing this Applic ation:

_______

Signature o f Person Authorizing this Applic ation:

____

_______

_________________Position
_______

Date __ /

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

HEALTH DETAILS
Name: ___________________________________________ Local Council: _______________________________________________
Special Heal th Pro blem (Do you have any i ll ness of the fol lowi ng?)
Heart di sease

Hay fever

Di abeti c

Hypertensi on

Fai nti ng

Haemop hi li a

Asthma

Epi l epti c

Sl eep Wal ki ng

Auti sm

Any other Al l ergi es

________ ________________

Any p hysi cal di sabili ty

________ ________

Others (pl ease s peci fy)

________ ________

Recommend ati on and/or res tri cti ons (i f none, so state): ____________________________________________________________________________
Physician (Signature over Prin ted Nam e):_____________________________________________________ License No.: ___________________
---------------- ----------------- ----------------- ----------------- ------------------ ----------------- ----------------- ----------------- ------------------ -----