CITY GOVERNMENT OF IMUS

YOUTH AFFAIRS OFFICE

Pista ng Kabataang Imuseño

Registration Form

PERSONAL INFORMATION
Name Paste your
MOST-RECENT 2x2
studio-taken
Last Name First Name Middle Name
colored picture here.
Nickname Age Gender Please do not staple.

Birth date (mm/dd/yyyy) Religion (White Background

only)
Residence Address

Residence Telephone No. Mobile Number E-mail Address

Name of Organization

I certify that all information furnished herein is true and correct. The above information is
given for the purpose of joining the Pista ng Kabataang Imuseño. I authorize the Youth
Affairs Office to verify any information contained in this application form and its
accompanying documents from, and obtain additional information about me if necessary.

I agree that the application remains as Youth Affair Office’s property and the same may be
used at their discretion, whether I am qualified or not. In case of disapproval of this
application, I hereby understand that the Youth Affairs Office is not obliged to disclose the
reason/s for such disapproval.

I authorize Youth Affairs Office to send me updates via SMS/text, email, or other means of
communication.

I fully understand that any misrepresentation or failure to disclose necessary information

on my part as required herein may cause disapproval/disqualification of my application, if
any.

Signature of Applicant over Printed Name Date Signed