Boy Scouts of the Philippines

CALOOCAN CITY COUNCIL

10TH Avenue, Caloocan City
E-mail: bsp.caloocancitycouncil@scouts.org.ph

APPLICATION TO ATTEND
1st SOUTH DISTRICTS FELLOWSHIP CAMP
Date: May 19-21, 2023 (Friday-Sunday)
Venue: St. Francis Forest Park, Brgy. Capihan, San Rafael, Bulacan

Name of Scout: Nick name:

(Surname), (Given) (Middle Name)

PARENT/ GUARDIAN: Nick name:

(Surname), (Given) (Middle Name)

School: District:

Age: Date of Birth: Place of Birth:

Home Address:

PARENT/ GUARDIAN Contact No. E-mail Address:

Please Check ( ) We/I agree to pay activity fee of (100.00) only.

(PARENT/GUARDIAN Signature over printed name)

Recommended by:

Institutional Head/Principal
(Signature over printed name)

ACTION OF THE LOCAL COUNCIL

Date Received:

Received by:

APPROVED:

DR. EMELANDO R. AREVALO, ALT w/CMT

Council Scout Executive
 Boy Scouts of the Philippines
CALOOCAN CITY COUNCIL
10TH Avenue, Caloocan City
E-mail: bsp.caloocancitycouncil@scouts.org.ph

PARENTS PERMIT
I, parent/guardian
of allow him/her to attend the 1st
SOUTH DISTRICTS FELLOWSHIP CAMP, May 19-21, 2023 (Friday-Sunday) at St. Francis Forest
Park, Brgy. Capihan, San Rafael, Bulacan.

WAIVER
I am aware of the risks connected with attending this event on this date. I agree to not hold
accountable or bring legal action against the council, their activity officers, unit leaders, or
council staff. This waiver releases the council from all liability relating to injuries that may
occur on location before, during, or after activity.

By signing this agreement, I agree to hold the council entirely free from any liability, including
financial responsibility for injuries incurred, regardless of the reasons or circumstances.

I acknowledge the risk involved with this activity including, but not limited to, muscle tears,
sprains, and other physical injuries. I certify that my child’s participation is voluntary, and I
have been made aware of the risks. Additionally, I guarantee that my child does not have any
conditions that may increase any likelihood of injury.

My child will make every effort to obey the activity officers and all his unit leaders, all safety
rules, and will ask for clarification if needed.

Parent’s/Guardian’s Signature Over Printed Name Date

Parent/Guardian Cellphone Number: