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    SUMMER YOUTH CAMP 2017 Individaul Form and Parental

    Uploaded by

    Glenn John Balongag
    This document is an individual registration form for a summer youth camp held from April 19-23, 2017 in the Vicariate of St. Paul. It requests personal details, emergency contact information, health details including allergies and medications, and signatures for authorization and waiver of liability. Parents must also provide consent for minor participants under 18 years old.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    SUMMER YOUTH CAMP 2017 Individaul Form and Parental

    Uploaded by

    Glenn John Balongag
    23 views2 pages
    This document is an individual registration form for a summer youth camp held from April 19-23, 2017 in the Vicariate of St. Paul. It requests personal details, emergency contact information, health details including allergies and medications, and signatures for authorization and waiver of liability. Parents must also provide consent for minor participants under 18 years old.

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    This document is an individual registration form for a summer youth camp held from April 19-23, 2017 in the Vicariate of St. Paul. It requests personal details, emergency contact information, health details including allergies and medications, and signatures for authorization and waiver of liability. Parents must also provide consent for minor participants under 18 years old.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    23 views2 pages

    SUMMER YOUTH CAMP 2017 Individaul Form and Parental

    Uploaded by

    Glenn John Balongag
    This document is an individual registration form for a summer youth camp held from April 19-23, 2017 in the Vicariate of St. Paul. It requests personal details, emergency contact information, health details including allergies and medications, and signatures for authorization and waiver of liability. Parents must also provide consent for minor participants under 18 years old.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    SUMMER YOUTH CAMP 2017

    April 19-23, Vicariate of St. Paul

    INDIVIDUAL REGISTRATION FORM


    _____________________________________________
    Origin (Write the Name of your Parish)

    A. PERSONAL DETAILS

    Sex : Last Name: First Name: Nickname:

    Birth date: ______________________________


    Address: ___________________________________________________________
    Email Address: ______________________________________________________
    Mobile Number: ___________________________________
    Educational Background: College: ____, High School: _____ Elementary: ____ Out of School Youth: ___
    Post Graduate: ______
    Event: ___________________________T-Shirt Size: _______________________
    B. CONTACT PERSON IN CASE OF EMERGENCY

    Full Name Relationship to You Contact Number

    C. HEALTH DECLERATION
    This Health Declaration will help the SYC2017 Organizers understand the health conditions of SYC2017 participants so as to provide timely support
    and to make necessary arrangements in the event of an emergency. Please provide accurate data.

    C.1 Allergy: Have you ever suffered from an allergy (e.g. medicine, food, etc.) YES NO

    If yes, provide details: ___________________________________________________________________


    C.2. Are you on regular medication: YES NO

    If yes, provide details on the medicine/s: ____________________________________________________


    C.3. Do you have a special diet (e.g. vegetable, meat, fish, less salt, etc.)? YES NO

    If yes, provide details: ___________________________________________________________________


    C.4. Will you require mobility assistance? YES NO

    If yes, provide details: ___________________________________________________________________

    IMPORTANT: If you Checked Yes to C.1 and/or C.2., SYC2017 organizers require that you seek your doctors advice before joining that you
    submit documentary proofs, e.g. doctors certification/medical allergy card/etc., with this form.

    D. AUTHORIZATION AND WAIVER


    I confirm that all information herein are correct and accurate to the best of my knowledge and I authorize the SYC2017 Organizers to use with
    discretion the information contained herein as the SYC2017 Organizers deem necessary in view of my participation to the SYC2017. I also
    understand that the SYC2017 organizers will not be held liable for any untoward incident that may occur to me during the event. I hereby attach my
    signature below to vouch for the veracity of the above statements.

    This portion must be signed by the participant accomplishing this form. If the participants is a minor (18 or below), then this must be signed by any
    of his/her parents or legal guardian.

    Full Name Signature Date Accomplished

    Parental Consent
    I __________________________________________________________________ , the parent/ guardian of
    ______________________________________________________, authorized him/her to join the Summer Youth
    Camp (SYC) of the Vicariate of St. Paul on April 19-23, 2017 that is to be held at St. Augustine of Hippo Parish
    San Juan, Siquijor. I will not take hold the organizers responsible for any untoward incidents that may happen to
    my child during the duration of the said activity.

    _______________________________________ ___ _______________ __________________________


    Signature over Printed Name of Parent/Guardian Date Parish Priest Signature

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