GSP Parents consent

Girl Scouts of the Philippines SURIGAO 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: ______________ ______________

Religious Affiliation: ___________________ __________________________ _______

Date of Last Registration: __________________ __________________ Number of Years in Scouting: _______________ _______________

Camps/Special Events Attended: Event

Date

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________________________ ________________________

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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. examination.  __________________  _______________________ _____ Date

Signed: __________________ ___________________________ __________________ _________________ ____________ ____ Parent/Guardian

CERTIFICATION & ENDORSEMENT We hereby certify t hat the applicant has met all requirements for participation in this event.  ___________________  _____________________________ __________ Troop Leader  __________________  __________________________ ________ Council President

__________________ __________________________ ________ Council Executive