YOUNG SERVANTS OF THE LORD

THE YOUTH ARM OF

SERVANT COMMUNITIES

2nd YSL-BUKIDNON GATHERING

OCTOBER 19-21, 2012
RAIHAK EVENTS VENUE AND RESORTS

_______________________________________________________________________________________________
MINORS CONSENT FORM
For participants aging 13 17 years young
Section to be completed by participant:
I confirm
rd

that I want to attend the 2ND YSL-BUKIDNON. I understand that the organizers of the said event shall be
responsible for my safety and welfare during the entire activities and I agree to cooperate fully with them. I understand
that if I do not cooperate with them, necessary disciplinary action shall be taken. Should my behavior be
uncontrollable, it may result in a discontinuation of my participation in this gathering and me having to return home
early (parents will be informed).
Signature of participant: ______________________________________________Date: ________________________
Full Name of participant: ___________________________________________Date of birth: ____________________
Section to be completed by parent / guardian:
I understand that the event will take place at the Raihak Venue and resort at Dologon Maramag,Bukidnon on Oct.19-21,2012.
I am aware that the contact persons for this activity should I have any further queries are:
Levi Lovitos (YSL Mindanao Area Servant)
Mobile: +63 915 4832567
932 2618505

Ralph S.Quirog (YSL Bukidnon Servant)

Mobile: +63 917 9114978

I hereby give consent for the above named participant to attend the 2nd YSL Bukidnon
Gathering
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Please give details of ANY medical condition/s, allergy, disability, etc. of which the organizers have to be aware.
Include details of any medication that has to be taken or special dietary requirements. (This information will be treated
as confidential).
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
I understand that I will be immediately contacted about any matters relating to my childs care or welfare. I give my
consent for any emergency medical treatment. I have discussed this form with the minor participant concerned, and
he/she knows what I have written
Signature of parent / guardian: _____________________________________

Date: ________________________

Full name of parent / guardian: ________________________________ Relationship to the participant: ____________

Complete Address: ______________________________________________________________________________
_______________________________________________________________________________
Land line No/s: __________________________ Mobile No/s: ____________________________________________

Please return completed form immediately to the organizers

Minors who do not have a completed consent form shall not be allowed to participate