ARCHDIOCESAN YOUTH DAY 2018 2x2 picture

26-29 October 2018, ST. FRANCIS XAVIER PARISH INITAO, MISAMIS ORIENTAL
Hosted by the Saint John Paul II Vicariate

Theme: “Young People, The Faith and Vocational Discernment (SYNOD 2018)”
ARCHDIOCESAN YOUTH COORDINATING COUNCIL- ARCHDIOCESE OF CAGAYAN DE ORO

AYD2018 INDIVIDUAL REGISTRATION FORM PHASE 1

This Registration Form Phase 1 (RF P1) aims to gather complete information about the AYD delegate. It must be fully accomplished.
Once accomplished, the Group Leader should submit this (RF P1) with the 300php Registration Fee/participant and 1,000.00php
Solidarity/parish ON or BEFORE September 10, 2018. Late submission of this form will NOT be entertained by the AYD Secretariat
Committee.

Origin (Group)

PERSONAL DETAILS

Title Last Name First Name M.I

Male Female

Date of Birth Month Year Gender Mobile Number

Current Address (City/Home Address)

CONTACT PERSON IN CASE OF EMERGENCY

Full Name Person’s relationship to you Mobile Number

HEALTH DECLARATION
This Health Declaration will help the AYD 2018 Organizers understand the health conditions of an AYD 2016 delegate so as to provide timely support to make
necessary arrangements in the event of emergency. Kindly provide the accurate data. Encircle your answers.

1. ALLERGY: Have you ever suffered from any allergy? (e.g. food, medicine, etc.)? A. Yes B. No
If yes, provide details: ____________________________________________________________________________
2. Are you on regular medication? A. Yes B. No
If yes, provide details: ____________________________________________________________________________
3. Do you have a special diet (e.g. vegetarian, meat, fish, less salt, etc.)? A. Yes B. No
If yes, provide details: ____________________________________________________________________________
1. Will you require mobility assistance? A. Yes B. No
If yes, provide details: ____________________________________________________________________________

Remarks: If you have an allergy (Item 1) or on a long-term medical treatment (Item 2), the AYD2016 Organizers requires that you seek your doctor’s advice before
joining this event and submit a copy of documentary proofs (e.g. doctor’s certification or medical allergy card) together with this form.

AUTHORIZATION AND WAIVER

I confirm that all information herein are correct and accurate to the best of my knowledge and I authorize the AYD2018 Organizers to use with
discretion the information contained herein as AYD2018 Organizers deem necessary in view of my participation to AYD2018. I also understand that
the AYD2018 Organizers will not hold liable for any untoward incident that may occur to me because of my own negligence during the event. I
hereby attach my signature below to vouch for the veracity of the above statements.

This portion must be signed by the participant accomplishing this form. If the participant is minor, this must be signed by a parent or a legal guardian.

Complete Name Signature Date Accomplished