0 ratings0% found this document useful (0 votes) 56 views3 pagesRoster and Application For PREJAM
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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
