Boy Scouts of the Philippines
Central Luzon Region
BATAAN COUNCIL
(Please type or Print legibly) Date: __________________
Name:__________________________________________________________________________________________________
Last Name First Name Middle Initial
Date of Birth: __________________________Place of Birth: ______________________________________________________
Height: ________________ Weight: ______________________ Religion: ____________________________________________
Mailing Address: _________________________________________________________Telephone No.____________________
Father’s Name: __________________________________Mother’s Name: ___________________________________________
Sponsoring Institution (SI): _________________________________________________________________________________
S.I. Address: _______________________________________________________Telephone No. _________________________
Scouting Position: ______________________________ Scout Unit No. __________ Rank: ______________________________
Membership Card No. __________________________________ Expiration Date: ____________________________________
Camping, Jamboree & Training experiences (Title, Venue, Inclusive Date):
_______________________________________________________________________________________________________
I do hereby agree to exert my very best to be worthy as a representative not only of the Boy Scouts of the Philippines but also my
District/School thru my strict observance of the Scout Ideals as embodied in the Scout Oath and Law.
And as faithful delegate, I shall obey and cooperate with Jamborette Leaders who have been authorized to exercise all actions
necessary to maintain the prestige of my District/School in particular and the Boy Scouts of the Philippines in general.
_______________________
Applicant Signature
APPROVAL OF PARENTS OR GUARDIAN
(For Applicants 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 account of any incident or injury or damage to
personal property that may occur beyond the control of the Contingent Officials/BSP provided adequate safety measures and precautions
have been instituted in connection with the participation of my son.
We further agree to have said Scout meet the health requirements which includes his examination by a Medical Officer who will
use the form provided by the BSP, for this purpose and to obtain certification from school authorizes attending to his academic standing.
___________________________ _____________________________
Father/Guardian Mother/Guardian
(Signature over printed Name) (Signature over printed Name)
CERTIFICATION
We hereby certify that the above applicant has met all the requirements for participation in this Scout event as set forth by the
Boy Scouts of the Philippines. We have personally interviewed the above applicant and found him physically fit and qualified to be a
member of the Contingent. He is currently registered and on the basis of his record of satisfactorily Scouting experience and his cooperative
attitude towards his fellow Scouts/Scouters, we recommend his acceptance as a member of the delegation.
______________________________ ________________________________
Institutional Head Troop Leader/Outfit Advisor
ACTION OF THE LOCAL COUNCIL
Received: LUISA H. SALAYA Approved:
Registration Officer
Date: ________________ MODESTO D. ANCHETA
Council Scout Executive
