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Application Form Health Examination Form Parents Consent Form

This document contains an application form, health examination form, and parents consent form for a Girl Scouts patrol leadership training camp. The forms collect personal information like name and contact details, medical history, and permission from a parent for their daughter to attend the training from August 31st to September 1st, 2018 at North Central School in Santiago City. The parent agrees to not hold the Girl Scouts responsible for any incidents beyond their control and provides 1000 pesos for snacks and meals.

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april rose cataina
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106 views1 page

Application Form Health Examination Form Parents Consent Form

This document contains an application form, health examination form, and parents consent form for a Girl Scouts patrol leadership training camp. The forms collect personal information like name and contact details, medical history, and permission from a parent for their daughter to attend the training from August 31st to September 1st, 2018 at North Central School in Santiago City. The parent agrees to not hold the Girl Scouts responsible for any incidents beyond their control and provides 1000 pesos for snacks and meals.

Uploaded by

april rose cataina
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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APPLICATION FORM HEALTH EXAMINATION FORM PARENTS CONSENT FORM

SCHOOL____________________________________ Name :_______________________________


To Whom It May Concern
PERSONAL DATA
Health History: (Check giving approximate dates)
1. Name:_______________________________ This is to permit my daughter to participate
2. Date of Birth:_________________________ Frequent Coids:________________________
in the PATROL LEADERSHIP TRAINING OF THE GIRLS
3. Home Address: _______________________ Kidney Trouble:________________________
SCOUT OF THE PHIL. held at NORTH CENTRAL
____________________________________ Chickenpox:__________________________
SCHOOL Santiago City on AUG, 31-SEPT, 1,2018.
4. Mobile Number:_______________________ Abscessed Ears:_______________________
5. Parent/Guardian:______________________ - Convulsion:___________________________
____________________________________ Mumps:______________________________
We will not hold the Girls Scouts of the
6. Person to notify in case of Emergency Fainting:_____________________________
Philippines responsible for any untoward incident
Name:_______________________________ Sleep Walking:________________________
that may happen beyond their control.
Address:_____________________________ Whooping Coughs:_____________________
____________________________________ Frequent Sore Throat:__________________
1,000.00 pesos (snacks and meals)
7. Religious Affiliation:____________________ Measles:_____________________________
8. Food Prohibition:______________________ Heart Trouble:_________________________
Bronchitis:____________________________
SCOUTING DATA Stomach Upsets:_______________________
1. Program Level:________ Troop No._______ Rheumatic Fever:______________________
2. Date of Last Registration:_______________ Constipation:_________________________
3. Camping Experience Tuberculosis:__________________________
District/School:_______________________ Operations of Serious Injuries:____________
Allergic Reactions:_____________________ Parent/Guardian
Provincial Camp:______________________
Penicillin: ____________________________ (Signature over printed name)
Regional Camp:_______________________

Other Drugs:___________________
IMPORTANT: Please notify the Council if this
____________________________________ applicant is exposed to any communicable diseases
Signature of Applicant 3 weeks
Poor to trip attendance

____________________________________
Name of Field Adviser/School Coordinator Licensed Physician

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