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GSP Parents consent
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Girl Scouts of the PhilippinesSURIGAO DEL NORTE COUNCIL
Surigao City
APPLICATION FORM(Girl and Adult)
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: ____________________________________________ Contact 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
__________________________ __________________________ Council President Council Executive