Boy Scouts of the Philippines

SOUTH COTABATO COUNCIL

Eastern Mindanao Region
BSP Bldg., Alunan Avenue, Brgy Zone IV
Koronadal City, Province of South Cotabato
Tel. No. (083) 228-2415 Mobile No. 09366913408

2023 COUNCIL JAMBOREE AND KAWAN HOLIDAY

08-11 February 2023
Nicolas Barreras National Hign School, Brgy Glamang, Polomolok, South Cotabato
THEME: “Sustaining Growth Amidst Pandemic”

PARTICIPATION/REGISTRATION FORM

Name: _________________________________________________________________________________ Nationality _____________________

Last Name First Name M.I.
Date of birth: ________________________ Place of Birth __________________________________________
Height: _____________________ Weight: __________________________ Religion: _______________________
Mailing Address: ______________________________________________ Tel/Celphone No. _________________
Email Add:___________________________________________________ Messenger Acct __________________
Father’s Name: ________________________________ Mother’s Name: ________________________________
Sponsoring Institution: __________________________________________________________________________
Scouting Position:____________________________ Scout Unit No. ________________ Rank: ________________
Membership Card No. __________________________ Expiration Date _________________________________
Camping Jamboree & Training experiences (Title, Venue, Inclusive Dates) : ________________________________
_____________________________________________________________________________________________
I transmit herewith
The full payment of P 350.00

Reservation Fee of P 150.00

I do hereby agree to exert my very best to be worthy as a representative not only of the Boy Scouts of the
Philippines but also of my Council/District/Institution thru my strict observance of the Scout Ideals as embodied in the Scout
Oath and Law.
And, as a faithful delegate, I shall obey and cooperate with Jamboree Leaders who have been authorized to exercise
all actions necessary to maintain the prestige of my Council in particular and the Boy Scouts of the Philippines in general.

___________________________
Applicant’s Signature

APPROVAL OF PARENTS OR GUARDIANS

(for applicants of minor age)
We hereby approve this application and certify to its correctness. In consideration of the benefits to be derived, we
expressly waive any and all claims against the Boy Scouts of the Philippines or its representatives on account of any incident
or injury or damage to personal property that may occur beyond the control of the Contingent Officials/BSP provided
adequate safety measures and precautions have been instituted in connection with the participation of my son/daughter in
the 2016 COUNCILWIDE JAMBOREE AND KAWAN HOLIDAY.
We further agree to have said Scout meet the health requirements which includes his/her examination by a Medical
Officer for this purpose and to obtain permission from the school authorities attesting to the fact that he/she may be excuse
and that his/her missing classes will not adversely affect to his/her academic standing.
____________________________ _______________________________
Father/Guardian Mother/Guardian
(signature over printed name) (signature over printed name)

MEDICAL CERTIFICATE
I HEREBY CERTIFY that I personally examined the above name applicant and have found out that he/she is physically
fit to undergo scouting activities in attending the 2016 COUNCILWIDE JAMBOREE AND KAWAN HOLIDAY.

REMARKS:
_____________________________________________________________________________________________
_____________________________________________________________________________________________

____________________________________ ________________________ ______________

Physician’s Signature Over Printed Name License No. Expiration Date
======================================================================================================
ACTION OF THE COUNCIL OFFICE:

Received by: ___________________________ Date: ______________________________ Remarks : __________________