Youth Development Program

Membership Form

First Name _______________________ Middle Name ___________________ Last Name _______________, extension ____
Sex: [ ] Male [ ] Female Date of Birth ___ / ___ / _______ Citizenship ____________ ___ Religion __________________

Complete Address:
_____________________________________________________________________________________________________
Street/Sitio Barangay City/Municipality Country Zip Code
Contact Information:
Telephone No. ___________________ Mobile No. ___________________ E-mail Address ____________________________

Parent/Guardian:
First Name ______________________ Middle Name ____________________ Last Name _______________, extension_____
Relationship _____________________ Telephone No. ___________________ Mobile No. ____________________________
Complete Address:

Street/Sitio Barangay City/Municipality Country Zip Code

Family Composition

No. Complete Name Sex (M/F) DOB Relationship Occupation Civil Status

Add extra sheet/s if necessary

The Youth-Link for Leadership and Development Association, YLLDA is a volunteer-driven youth organization created and
established to develop youth members to become productive and responsible citizen of the country thru a Youth Development
Program (YDP).

In consideration of gaining membership or being allowed to participate in the activities and programs of YLLDA, I do hereby
waive, release, and forever discharge the YLLDA and its officers, employees, representatives, and all others from any and all
responsibilities or liability for injuries or damages resulting from my participation in any activities. I agree to adhere to all policies set
by the YLLDA. I also agree that membership is not transferable and membership fees and contributions are not refundable.

Name and Signature of Member _______________________________ __________________ Date _________________________

Name of Parent/Guardian and Signature __________________________________________ Date _________________________

Recommending Approval: Approved:

___________________________________ _____________________________________ Attach latest 2x2

Signature above printed name/Designatio Signature above printed name/Designation
picture here
Date: __________________________ Date: _________________________

Type of Membership/Fee:

New Membership/P100 [ ] Renew or Annual Membership/P100 [ ] Complete Membership/P500 [ ]