18TH NATIONAL SCOUT JAMBOREE

UNIT LEADER’S APPLICATION FORM

PASSI CITY, PROVINCE OF ILOILO ● 08 - 18 DECEMBER 2023
THEME: “Youth Engagement: Sustaining Relevance and Strengthening Resilience”

Name
Family Name Given Name Middle Name

Present Address
Email Address Contact #
Date of Birth Place of Birth Age
Religion Civil Status Gender
Council TAGUIG CITY COUNCIL Region NATIONAL CAPITAL REGION
School _______________
Unit # Membership Card # Date of Registration
Position in the Troop/Outfit Current Rank

PARENT’S / GUARDIAN’S CONSENT

I understand that the participation in Scouting activities involves a certain degree of risk and can
be physically, mentally, and emotionally demanding. I have carefully considered the risk
involved and have given consent for myself to participate in this activity. I also understand that
participation in this activity is entirely voluntary and requires participants to abide by applicable
rules and regulations and standards of conduct. I release the Boy Scouts of the Philippines, the
Taguig City Council, City Government of Taguig and DepEd-Taguig, the activity coordinators,
and all professional staff, volunteers, related parties, or other organizations associated with the
activity from any and all claims or liability arising out of this participation.

In case of emergency, I understand that every effort will be made to contact my immidiate
family. In the event that they cannot be reached, I hereby give my permission to the seleclted or
attending medical provider or in charge of the Contingent Management Team to secure proper
treatment, including hospitalization, anesthesia, surgery, or injections of medication for myself.
Medical providers are authorized to disclose to the adult in charge examination findings, test
results, and treatment provided for purposes of medical evaluation of the participant, follow-up
and communication with family, and/or determination of the participant’s ability to continue in the
program activities.

______________________________________________
Signature over Printed Name
Date ______________________

ACTION OF THE SPONSORING INSTITUTION

This is to certify that Mr/Ms/Mrs , is a bonafide
member of the Boy Scouts of the Philippines registered in this institution, under the Taguig City
Council.

______________________________________
Institutional Head / Representative
Date ___________________

ENDORSEMENT OF THE LOCAL COUNCIL

Registration Status I hereby certify the veracity of the details and endorse the
` participation of Mr/Ms/Mrs _________________
Reservation Fee: to the 18th National Scout Jamboree.
Balance:
Full Payment:
Date: RAYMUNDO D. R. MARCELO, ALT w/ CMT
OR No. Council Scout Executive/Officer-in-Charge
Date

NOTARY PUBLIC