Philippine Red Cross

Red Cross Youth

Cebu Chapter

P-1 FORM

MEMBERSHIP FORM

Blood Type: ______________________

RCY ID No.: _____________________
Committee Membership: _________________________

A. PERSONAL DATA
Name: _______________________________________________________ Nickname: _____________________
Age: ___________ Civil Status: _________Contact No.:_______________ Height: _______ Weight: _______
Birthdate: ________________ Nationality: ________________________ Religion: ___________________
City Address: ____________________________________________________________ Tel. #: ______________
Provincial Address: _______________________________________________________ Tel. #: ______________
Ailments: _____________________________________________________ Allergies: _____________________
Hobbies: ___________________________________________________ Special Skills: ____________________
Father’s Name: _____________________________________ Occupation: _______________________________
Address: ____________________________________________________________ Tel. #: __________________
Mother Name: ______________________________________ Occupation: _______________________________
Address: _______________________________________________________________ Tel. #: _______________
In case of emergency please contact:
Guardian: _________________________________________ Occupation: ________________________________
Address: _______________________________________________________________ Tel. #: _______________

B. EDUCATIONAL BACKGROUND
Presently enrolled at: _____________________________________________________________________
Course & Year: _____________________________ School Address: ______________________________
EDUCATIONAL ATTAINMENT: INCLUSIVE DATES
a. Elementary:____________________________________________________ ___________________
b. Secondary: ____________________________________________________ ___________________
c. College: _______________________________________________________ ___________________
d. Vocational: ____________________________________________________ ___________________

C. RED CROSS TRAININGS ATTENDED

Training Attended Place Inclusive Dates
___________________________________ ____________________________ _______________
___________________________________ ____________________________ _______________
___________________________________ ____________________________ _______________
___________________________________ ____________________________ _______________
___________________________________ ____________________________ _______________

D. AFFILIATION WITH OTHER ORGANIZATIONS

Organization Position Council Dates
______________________________ _____________________ __________________ ______________
______________________________ _____________________ __________________ ______________
______________________________ _____________________ __________________ ______________

I hereby certify to the correctness of the foregoing information.

________________________________________ ______________________________________
Signature of Member Council President

________________________________________ ______________________________________
Date Filed Council Adviser
Kindly write your schedule of classes and sketch of home at the back