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PROVINCIAL JUNIOR/SENIOR AND CADET CAMP 2023

REPLY SLIP

(Please submit on or before November 10, 2023)

DISTRICT: Pontevedra 1 DIVISION: Negros Occidental

Troop

(Sample: T-Shirt
Name School Contact Number
Junior Troop Size
No. 1)

1.Celine B.Espinosa Junior Recreo Elem.School 09810569948 S

2.Keezhia Nicole D. Gumatas Junior Recreo Elem.School 09810569948 XS

3.Zamantha C. Dorio Junior Recreo Elem. School 09103814732 XS

4.Ashley B. Baylon Junior Recreo Elem. School 09081569957 XS

5.Jian Marielle F. Valiente Junior Recreo Elem.School 09995839013 XS

6.Rheanna M. Miranda Junior Recreo Elem.School 09319090730 XS

7.Claire Gracel A.Parrenas Junior Recreo Elem. School 09459659529 XS

8.Lumen H. Kilayco Troop Leader Rereo Elem.Shool 09995839013 M

Submitted by:

LUMEN H. KILAYCO ____________________

Troop Leader Division Coordinator

 GIRL SCOUTS OF THE PHILIPPINES
NEGROS OCCIDENTAL GIRL SCOUT COUNCIL
Araneta St., Singcang, Bacolod City
Telefax No. (034) 431-4600
E-mail Address: negoccgscouncil@yahoo.com.ph
APPLICATION FORM
(GIRL)
Event: Date:

PERSONAL DATA:

Name:

LAST MIDDLE FIRST

Date of Birth: Age: Home Address:

Troop Number: Council: Date of Last Registration:
Religious Affiliation: Number of Years in Scouting:
Camps/Special Events Attended:

Event Date

In emergency, notify: Relationship:

Address: Telephone Number:

PARENT’S CONSENT

This is to certify that I have given full consent for my daughter

to participate at the

I have considered the benefits that my daughter will derive from her participation in this
activity with the understanding that every precaution is to be taken to ensure her safety.

I shall not hold the Girl Scouts of the Philippines or its representative responsible for any
untoward accident that may happen beyond their control. Her physical fitness is assured in a medical
examination.

Signed:
Date Parent/Guardian

CERTIFICATION & ENDORSEMENT

We hereby certify that the applicant has met all requirements for participation in this event.
Troop Leader Division Girl Scout Coordinator