Boy Scouts of the Philippines National Office 181 Natividad Almeda-Lopez St. Ermita, 1000 Manila, Philippines E-mail: bsp@scouts.org.ph

(632) 528-0555 * (632) 527-5109 * (632) 527-8317 to 20 * Fax (632) 528-0577

07 January 2019 NATIONAL OFFICE MEMORANDUM Number 01 series 2019 TO : Regional Scout Directors, Council Scout Executives and Officers-In-Charge SUBJECT : ADDITIONAL INFORMATION – 24TH WORLD SCOUT JAMBOREE Further to National Office Memorandum No. 47 dated 29 September 2017, we are pleased to provide the following additional information relative to the conduct of the 24th World Scout Jamboree for your guidance and reference as approved during the National Executive Board in its meeting on 15 December 2018, as follows. 1. Final Registration Deadlines and Philippine Contingent Schedule

Tue, 15 January 2019 Deadline of submission of Application Form for 24th World Scout Jamboree

Thu, 31 January 2019 Deadline of 24th WSJ Online Registration and Payment of Jamboree Fee (IST-USD588.00 and Contingent USD638.00)

Fri, 15 February 2019 Deadline of submission of Visa Application Form with Original Philippine Passport old and new (see attached form)

Thu, 28 February 2019 Deadline of Personal Appearance for US Embassy Interview (based on embassy schedule)

Mon, 15 July 2019 (AM) Arrival of all approved International Service Team (IST) in Manila

Mon, 15 July 2019 Orientation for International Service Team

Tue, 16 July 2019 Departure of the International Service Team for West Virginia, USA

Sat, 20 July 2019 (AM) Arrival of all Philippine Delegation (CMT, Scout Leaders and Scouts) in Manila

Sat, 20 July – Sun, 21 July 2019

Pre-Jamboree Training

Sun, 21 July 2019 Departure of Philippine Delegation (CMT, Scout Leaders & Scouts) for West Virginia, USA

Mon, 22 Jul – Fri, 02 Aug 2019

24th World Scout Jamboree Proper

Mon, 29 Jul (12noon) Philippine Day Celebration

Fri, 02 Aug 2019 Departure of All Philippine Delegation (CMT, Scout Leaders, IST & Scouts) for Manila

Sat, 03 Aug 2019 Arrival of All Philippine Delegation in Manila

2. Flight Arrangement/Schedule:

Based on the update of the 24th World Scout Jamboree Committee herewith are the

arrival and departure information at the venue, as follows:

a. official points of entry/departure for the National Scout Organization, as follows:

- Yeager Airport – CRW – Charleston, West Virginia

- Charlotte Douglas International Airport – CLT – Charlotte, NC

- Prince Amtrack Train Station – PRC – Prince, West Virginia

b. Contingents (Contingent Management Team, Scout Leaders and Scouts) MUST

ARRIVE and DEPART on the dates below:

Arrival in WV, USA : Monday, 22 July 2019 Departure in WV, USA : Friday, 02 August 2019

c. International Service Team

Arrival in WV, USA : Wednesday, 17 July 2019 Departure in WV, USA : Friday, 02 August 2019 or Saturday, 03 August 2019

Upon approval of the participants’ application by the National Office, we shall arrange

the contingent flight booking, however, should participants opt to get their own plane

ticket, they must strictly follow the contingent flight schedule below:

a. Contingent Management Team, Unit Leaders and Scouts

21 July 2019 Manila-Los Angeles PR-112 1125/1000 21 July 2019 Los Angeles-Charlotte AA-707B 2240/0634 (+1) 02 August 2019 Charlotte-Los Angeles AA-1952 1459/1712 03 August 2019 Los Angeles-Manila PR-103 0050/0615 (+1)

b. International Service Team

16 July 2019 Manila-Los Angeles PR-112 1125/1000 16 July 2019 Los Angeles-Charlotte AA-707B 2240/0634 (+1) 02 August 2019 Charlotte-Los Angeles AA-1952 1459/1712 03 August 2019 Los Angeles-Manila PR-103 0050/0615 (+1)

3. The revised estimated cost of participation fee as of 07 January 2019:

a. Contingent (CMT, Scout Leaders and Scouts)

PARTICULAR US DOLLAR PHILIPPINE PESO

Jamboree Fee 638.00

Airfare (roundtrip) 1,795.00

US Visa Fee 8,880.00

US Visa Processing Fee

(personal orientation, review of the

documents, US online schedule and

assistance during interview)

5,000.00

Supplies

(5 pcs of Contingent Strip, 5 pcs

Contingent Patch, International

Neckerchief and Salakot)

1,700.00

Backpack 10,492.50

Daypack 4,117.50

Pre-Jamboree Training 1,800.00

Contingencies fund (meals during

travel – 21 July & 02 Aug 2019)

100.00

TOTAL US$2,533.00 Php31,990.00

b. International Service Team

PARTICULAR US DOLLAR PHILIPPINE PESO

Jamboree Fee 588.00

Airfare (roundtrip) 1,795.00

US Visa Fee 8,880.00

US Visa Processing Fee

(Personal orientation, review of the

documents, US online schedule and

assistance during interview)

5,000.00

Supplies

(5 pcs of Contingent Strip, 5 pcs

Contingent Patch, International

Neckerchief and Salakot)

1,700.00

Backpack 10,492.50

Daypack 4,117.50

Orientation 1,800.00

TOTAL US$2,383.00 Php31,990.00

NOTE: Airfare, US Visa Fee and US Visa Processing Fee are subject to change without

prior notice.

4. Things to bring:

Camping Essentials

- Lace up, closed-toe shoes or broken-in (not new) hiking boots

- Sleeping Bag with a light weight stuff sack

- Sleeping pad

- Pillow

- Water shoes (optional)

Clothing - Scout uniforms

- Neckerchiefs

- Daily Clothing (4-5 sets)

- Socks (4-5 pair)

- Hat/Bandana

- Jacket or sweatshirt

- Rain gear

- Sleep clothes (2 sets)

- Underwear (5 pair)

Personal Gear - Towels (2)

- Hand towels (2)

- Water bottles (2)

- Day pack

- Personal eating gear

- Flashlight/headlamp with extra batteries

- Insect repellant – non-aerosol

- Toiletries: soap, toothbrush, toothpaste, foot powder, lip balm, sunblock

Philippine Day Celebration (29 July 2019) - Barong Tagalog with Slack Pants

- Black Shoes

- Local Delicacies

- White Shirt with Red Pants (for cultural presentation)

Optional Extra Items - Swim suit

- Camp Chair

- Smart phone

- Personal first aid kit

- Dry sack

- Solar charger

5. Food Distribution

Each campsite is provided with cooking equipment and propane cooking stove, the

participants however shall provide their personal eating gears. (See annex “A” for your

reference)

The Unit/Troops will plan and prepare their own menus, the Jamboree Food Market is

available which sells goods, produce, dairy, meats and more.

6. Attached herewith is the List and status of the Philippine Delegation as of 15 December

2018.

Should you have any question/s and/or query/ies you may refer to the International

Affairs Section, Field Operations Division through the following persons:

MR. SOFRONIO D. HONTANOSAS

Acting Director, Field Operations Division

ron.hontanosas@gmail.com

(02) 527-5112 local 528

MR.. MANUEL G. ISIDORO, III

Field Services Executive for International Affairs

butch.isidoro@scouts.org.ph / butz.isidoro@gmail.com

(02) 527-5112 local 509

For information, guidance, compliance and widest dissemination. ROGELIO S. VILLA, JR. Secretary General Encl.: International Application Form US Visa Application Form List and Status of the Philippine Delegation

BOY SCOUTS OF THE PHILIPPINES NATIONAL OFFICE

Manila

LIST OF PARTICIPANTS (As of 07 January 2019)

Confirmed Participants

ATTENDEE TYPE

REG CODE FIRST NAME LAST NAME

CMT 641-731271-8216 Wendel Avisado

CMT 641-787491-6691 Roberto Pagdanganan

CMT 641-787482-1514 Dale Corvera

CMT 641-731272-9568 Rogelio Villa

CMT 641-686645-3038 Cedrick Train

CMT 641-720036-2132 Danilo Asiaten

CMT 641-575142-2361 Manuel Isidoro

Adult Leader 641-686654-3716 Martin Ma. Antonio Train

Adult Leader 641-732969-8514 Markwil Bert Ramos

Adult Leader 641-756296-6133 Romel Ramos

Adult Leader 641-718710-3352 Jayson Taruc

Adult Leader 641-720627-3997 Jose Mangahas

Adult Leader 641-735776-4733 Jireh Parpa

IST 641-771849-1631 Rosalinda Jacinto

IST 641-738471-5914 Emilio Aquino

IST 641-724080-6750 Paula Marie Buenaventura

IST 641-718779-8799 Mhel Corpuz

IST 641-718822-2835 Mizzi Corpuz

IST 641-717370-6861 Sean Marie Prythyll Patnubay

IST 641-718829-9283 Vann Vincent Villanueva

IST 641-717797-8339 Gil Alcira

IST 641-732286-3776 Roberto Miguel Jorvina

IST 641-684106-4307 Oliver John Christian Liu

IST 641-696635-2555 Justin Edward Asiaten

IST 641-732932-9265 Ma. Alyssa Jeline Lamorena

IST 641-717213-6085 Jan Rainier Balaria

IST 641-578901-5752 Dionisio Ramosa

IST 641-576969-8604 Charlie Cameros

IST 641-615708-8985 Sophia Castillo

IST 641-575124-1261 Gerry Tan

IST 641-756235-3975 Arnold Eugenio

IST 641-741812-4628 Elizabeth Asiaten

IST 641-771055-3341 Arthur De Borja

IST 641-744470-1433 Chinno Marquez

IST 641-698746-2188 George Ceballo

IST 641-698759-9296 Dina Ceballo

IST 641-772450-7311 Mabini Baluyut

IST 641-770201-6668 Aaron Kenneth Vinluan

IST 641-734431-9527 Gladys Amylaine Sales

IST 641-732946-1116 Portia Mallorca

Scout 641-733390-6270 Johann Capanas

Scout 641-738612-6221 Jude Enrique Capanas

Scout 641-729541-5159 Simon Henry Damaso

Scout 641-722944-7686 Francis Angelo De Leon

Scout 641-720825-6336 Cer Jordan Duetes

Scout 641-741107-3966 Joeven Rey Gelera

Scout 641-735840-2283 Renzo Ricardo King

Scout 641-733706-4173 Ryan Julian Roy Lagmay

Scout 641-720819-2512 Winnie Francine Lim

Scout 641-720026-8603 John Jazper Luna

Scout 641-740113-2468 Miguel Philippe Malapitan

Scout 641-726983-9293 Jason Paul Mendez

Scout 641-733724-3721 Toby Gabriel Navarro

Scout 641-737768-7783 Sebastian Otero

Scout 641-737808-2262 Mary Seantheim Chillin Patnubay

Scout 641-734591-9958 Billian Stiles

Scout 641-686632-2471 Benedict Carmelo Train

Scout 641-727396-3686 Ken Genesis Acopio

Scout 641-727428-9110 Arian Gabriel Angeles

Scout 641-718820-4865 Mia-Ariana Capiendo

Scout 641-719722-8700 A-Feiah Dadacay

Scout 641-718766-9838 Bern Adie Matthew Ducusin

Scout 641-720666-6557 Mark Angelo Eduardo

Scout 641-732692-7590 Jannah Loristella Esguerra

Scout 641-721588-3531 Regina Marga Galano

Scout 641-733105-1221 Riggs Remegio Gerona

Scout 641-732978-1514 Aedan Zire Gumban

Scout 641-720083-8268 Ryo Kawamoto

Scout 641-732258-2371 David Thomas Miguel

Scout 641-775490-2063 Joan Blasquenio

Scout 641-718783-8751 Arvie Marie Pascual

Scout 641-733410-6654 J Surtsey Devin Salazar

Scout 641-719512-8668 Marie Katherine Joyce Turingan

Scout 641-731768-6253 Kevin Andrew Vinluan

Scout 641-733405-5325 Jefferson Yu

Scout 641-766098-6609 Shaeda Tedding

Scout 641-733772-7490 Alfonzo Chu

Scout 641-721999-2195 Julia Andrea Crisostomo

Scout 641-731811-7993 Gerard Gabrielle Duquette

Scout 641-718764-3439 Bianca Mae Elpedes

Scout 641-734170-3162 Dans Uriel Ferrer

Scout 641-732241-4575 Emmanuel Granada

Scout 641-727419-1481 Manuel Luis Javelona

Scout 641-733391-3159 Hue Cayrene Lu

Scout 641-726978-6938 Joshua Paul Mendez

Scout 641-732974-9207 Patrick Patangan

Scout 641-731374-1590 Joyce Katrina Sembrano

Scout 641-733781-2092 Nessa Marie Tibon

Scout 641-686633-1441 Fatima Joan Train

Scout 641-727423-7214 John Rhynhart Evidente

Scout 641-720685-8291 Liam Felix Lara

Scout 641-731609-2402 Janine Jarlos

Scout 641-721869-9608 Joseph Mielle Paroginog

Scout 641-754989-5912 Joshed Santiago

Scout 641-787601-6686 Dan Joseph Tagra

Scout 641-748525-4740 Kristina Olaguer

Scout 641-720795-2470 Acey Errol Simbillo

Solidarity Program

ATTENDEE TYPE

REG CODE FIRST NAME LAST NAME

Scout 641-720043-8249 Jonas Olalio

Scout 641-723268-3242 Ira Sadatek Borja

List of Participants for Jamboree Fee Payment / BSP Evaluation / Online Registration

ATTENDEE TYPE REGISTRATION CODE

NAME

IST 641-720695-3546 Wilbert De Ramos

IST 641-737020-2542 Mirasol Reyes

IST 641-578797-3745 Maria Jonalyn Cudia

IST 641-737654-4805 Bernando De Leon

IST 641-732948-4407 Juvy Gavileno

IST 641-685622-8291 Kervin Clyde Go

IST 641-659689-2394 Janice Gonzales

IST 641-731828-4330 Roberto Maguad

IST 641-676941-4086 Mark Martin

IST 641-578778-6378 Reynaldo Montano

IST 641-712212-1328 Robinson Obiles

IST 641-720013-9396 Yasser Sarona

IST 641-731808-4246 Elsie Tanate

IST 641-659725-1793 Bonifacio Train

IST 641-737026-3021 Mirasol Victoria

IST 641-685634-7824 Judelio Yap

IST For online reg Pao Co

IST For online reg Alvin Ivan Herrera

IST For online reg Patricia Marie Roldan

IST For evaluation Fr. John Christian Young

Unit Leader For evaluation Benjie Lasam

Scout 641-718756-8997 Angela Shane Agustin

Scout 641-732066-6515 Joanna Joy Alfanta

Scout 641-719707-1302 Sweet Angeles

Scout 641-719716-4210 Yvanna Hart Angeles

Scout 641-737826-6859 Roald Eras Xavier Bautista *

Scout 641-731798-6250 Mylene Bunyi *

Scout 641-720040-2944 Sonny Jose Dilao

Scout 641-763527-7720 Kristene Aem Grantos

Scout 641-769862-1806 Aubrey Mae Herrera

Scout 641-731809-3036 Lance Adrian Jacoba

Scout 641-770787-2483 Alexis Mariz Roldan

Scout 641-771388-8719 Mariella Castrene Villanueva *

Scout For online reg Francis Eugene Young

Scout For online reg Adrian Gil Urag

Scout For online reg Anthony Carl Jose Asuncion

Scout For evaluation Andre Juris

Scout For evaluation Alexis Emmanuel Bravo

Scout For evaluation Mark Russel Mahinay

Scout For evaluation Ace Axel Echavia

Scout For evaluation Job Estobo

Scout For evaluation Grabriel Mari Bulawan

Note: * - with Land Bank of the Philippines Deposit slip for BSP verification

US VISA APPLICATION DS-160

PERSONAL INFORMATION

Surname __________________________________________________

Given Names __________________________________________________

Full Name in Native Alphabet __________________________________________________

Other Surnames Used __________________________________________________

Sex / Marital Status __________________________________________________

Date of Birth __________________________________________________

Place of Birth __________________________________________________

Country of Birth __________________________________________________

Nationality __________________________________________________

Do you hold other Nationality __________________________________________________

Home Address __________________________________________________

__________________________________________________

Mailing Address __________________________________________________

__________________________________________________

Home Phone No. __________________________________________________

Work Phone No __________________________________________________

Work Fax No __________________________________________________

Mobile/Cell Phone No __________________________________________________

Email Address __________________________________________________

PASSPORT INFORMATION

Passport No __________________________________________________

Date of Issue __________________________________________________

Date of Expiry __________________________________________________

Place of Issue __________________________________________________

Have you ever lost/stolen a passport Yes / No ______________________________________

TRAVEL INFORMATION

Purpose of Trip to US __________________________________________________

Intended Date of Arrival __________________________________________________

Length of Stay in US __________________________________________________

Address where you will stay in US __________________________________________________

__________________________________________________

Who will pay for your trip? __________________________________________________

Names & Relationships of Persons

traveling with you __________________________________________________

Have you ever been in the US __________________________________________________

Previous US Visits / for How Long __________________________________________________

Have you even been issued a US Visa ____________________________________________

Date of Issue / Visa Number __________________________________________________

Are you applying in the same country ____________________________________________

Where the visa above issued? ____________________________________________

Have you been ten-printed? ____________________________________________

Has your US Visa ever been lost or Stolen? ____________________________________________

Has your US Visa ever been cancelled or revoked? ______________________________________

Have you ever been refused a US Visa? ____________________________________________

Date of refusal / Visa Type __________________________________________________

Do you intend to work in the US? __________________________________________________

Do you intend to Study in the US? __________________________________________________

US CONTACT

Contact Person __________________________________________________

Give Names __________________________________________________

Organization Name if Applicable __________________________________________________

Relationship to you __________________________________________________

Address __________________________________________________

__________________________________________________

Telephone __________________________________________________

Email Address __________________________________________________

FAMILY INFORMATION

Father's Full Name / Date of Birth __________________________________________________

Is your father in the US? __________________________________________________

Mother's Full Name / Date of Birth __________________________________________________

Is your mother in the US? __________________________________________________

Do you have any immediate relatives,

not including parents in the US? __________________________________________________

Relative Name __________________________________________________

Relationship to you __________________________________________________

Status: ie US Citizen; US Legal Permanent; other ______________________________________

Spouse's Full Name __________________________________________________

Date of Birth / Place of Birth __________________________________________________

Nationality __________________________________________________

Address __________________________________________________

__________________________________________________

List All Countries You Have entered in the Last five years _________________________________

________________________________________________________________________________

WORK / EDUCATION / TRAINING INFORMATION

Primary Occupation __________________________________________________

Present Employer __________________________________________________

Address __________________________________________________

__________________________________________________

Monthly Salary in Local Currency __________________________________________________

Position / Briefly Describe your Duties ____________________________________________

__________________________________________________

From dd-mm-yy __________________________________________________

To: dd-mm-yy __________________________________________________

Previous Employer __________________________________________________

Address __________________________________________________

__________________________________________________

Telephone __________________________________________________

Job Title __________________________________________________

Supervisor's Name __________________________________________________

Monthly Salary in local Currency __________________________________________________

Briefly Describe your Duties __________________________________________________

__________________________________________________

From dd-mm-yy __________________________________________________

To: dd-mm-yy __________________________________________________

Name of Institution

Name of School __________________________________________________

Address / Telephone __________________________________________________

__________________________________________________

Course of Study __________________________________________________

Date of Attendance

From: dd-mm-yy __________________________________________________

To: dd-mm-yy __________________________________________________

Name of School __________________________________________________

Address / Telephone __________________________________________________

__________________________________________________

Course of Study __________________________________________________

Date of Attendance

From: dd-mm-yy __________________________________________________

To: dd-mm-yy __________________________________________________

SECURITY & BACKGROUND INFORMATION

Do you have a communicable disease

of public health significance such as tuberculosis(TB)? YES or NO

Do you have a mental or physical disorder

that poses or is likely to pose a threat

to the safety or welfare of yourself or others? YES or NO

Are you have you ever been a

drug abuser or addict? YES or NO

Have you ever been arrested or convicted

for any offense or crime, even though subject

of a pardon, amnesty, or other similar action? YES or NO

Have you violated, or engaged in a conspiracy

to violate, any law relating to controlled substances? YES or NO

Are you coming to the US to engage in

prostitution or unlawful commercialized

vice or have you been engaged in prostitution

or procuring prostitues within the past 10 years? YES or NO

Have you ever been involved in,

or do you seek to engage in, money laundering? YES or NO

Do you seek to engage in espionage, sabotage,

export control violations, or any

other illegal activity while in the US? YES or NO

Do you see to engage terrorist activities

while in the US or have you ever engaged in terrorist activities? YES or NO

Have you ever or do you intend to provide

financial assistance or other support to terrorist organization? YES or NO

Have you ever ordered, incited, commited,

assisted, or otherwise participated in genocide? YES or NO

Have you ever committed, ordered, incited,

assisted, or otherwise participated in torture? YES or NO

Have you committed, ordered, incited, assisted,

or otherwise participated in extrajudicial killings,

political killings, or other acts of violence? YES or NO

Have you, while serving as a government official,

been responsible for directly carried out, at any time,

particularly severe violations of religious freedom? YES or NO

Have you ever been the subject of a

removal or deportation hearing? YES or NO

Have you ever sought to obtain or assist others

to obtain a visa, entry into the US, or any other

US immigration benefit by fraud or willful

misrepresentation or other unlawful means? YES or NO

Have you failed to attend a hearing on resolvability

or inadmissibility within the last five years? YES or NO

Have you ever been unlawfully present, overstayed

the amount of time granted by an immigration

official or otherwise violated the terms of a U.S. Visa? YES or NO

Have you ever withheld custody of a

U.S. Citizen child outside the US from

a person granted legal custody by a U.S. Court? YES or NO

Have you voted in the US in violation

of any law or regulation? YES or NO

Have you ever renounced US citizenship

for the purpose of avoiding taxation? YES or NO

Have you attended a public elementary school

on student(F) status or a publicsecondary school

after November 30, 1996 without reimbursing the school? YES or NO

Did anyone assist you in filling out this application? YES or NO

if YES provide details

Full Name __________________________________________________

Relationship to Applicant __________________________________________________

Address __________________________________________________

__________________________________________________

BOY SCOUTS OF THE PHILIPPINES NNAATTIIOONNAALL OOFFFFIICCEE

MMaanniillaa

AAPPPPLLIICCAATTIIOONN FFOORRMM ((ffoorr IInntteerrnnaattiioonnaall EEvveennttss))

PPlleeaassee ccoommpplleettee aallll ppaarrttss ooff tthhee aapppplliiccaattiioonn ffoorrmm iinn bblloocckk lleetttteerrss

SSccoouuttiinngg EEvveenntt:: ____________________________________________________________________________________________________________________________________________________________________

NNaammee ooff LLooccaall CCoouunncciill:: ____ RReeggiioonn:: ____________________________________________________________

PPEERRSSOONNAALL DDEETTAAIILLSS::

SSuurrnnaammee:: __________ FFiirrsstt NNaammee:: ______________________ MMiiddddllee IInniittiiaall:: ______ NNiicckknnaammee:: ________________________

GGeennddeerr:: DDaattee ooff BBiirrtthh:: ______// ______ //__________ ((dddd//mmmm//yyyy)) PPllaaccee ooff BBiirrtthh:: ____ ______

HHeeiigghhtt:: __ WWeeiigghhtt:: __________ BBlloooodd TTyyppee:: ________ NNaattiioonnaalliittyy:: RReelliiggiioonn:: ______________ ____________

FFaatthheerr’’ss NNaammee:: ______ ______ __________________ MMootthheerr’’ss NNaammee:: ________________________________ ____ ______ ____________

HHoommee AAddddrreessss:: ______________ ______________ CCiittyy//PPrroovviinnccee:: ________________________ ZZiipp:: ____________

TTeell NNoo..:: MMoobbiillee NNoo..:: FFaaxx NNoo..:: __ EE--mmaaiill:: ________________________

PPaassssppoorrtt NNoo..:: ____________________________________ DDaattee iissssuuee:: ______________________________________ DDaattee ooff eexxppiirraattiioonn:: __________________________________________

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SScchhooooll oorr PPrrooffeessssiioonn:: ______________ ______________ GGrraaddee oorr LLeevveell ooff EEdduuccaattiioonn::

AAddddrreessss:: ______________________________________________________________________________________________________________ TTeelleepphhoonnee NNoo:: ________________________________________

SSccoouuttiinngg PPoossiittiioonn:: __________________________________________________ SSccoouutt UUnniitt:: ________________________________ RRaannkk:: ______________________________________________

MMeemmbbeerrsshhiipp CCaarrdd NNoo..:: ________________________________________________________________________________ EExxppiirraattiioonn DDaattee:: ______// ______ //__________ ((dddd//mmmm//yyyy))

CCaammppiinngg,, JJaammbboorreeee && TTrraaiinniinngg eexxppeerriieenncceess ((TTiittllee,, VVeennuuee,, aanndd IInncclluussiivvee DDaatteess))::

____________________________________________________________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________________

HHoonnoorrss//AAwwaarrddss//RReeccooggnniittiioonn rreecceeiivveedd ((OOrrggaanniizzaattiioonn,, TTiittllee ooff aawwaarrdd aanndd ddaattee rreecceeiivveedd))::

____________________________________________________________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________________

SSppeecciiaall SSkkiillllss//QQuuaalliiffiiccaattiioonnss:: ______________________________________________________________________________________________________________________________________________

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CCOONNTTAACCTT PPEERRSSOONN IINN CCAASSEE OOFF EEMMEERRGGEENNCCYY::

NNaammee:: __ ______________

RReellaattiioonnsshhiipp:: AAddddrreessss:: __________________________________________________________________________________________________________________________

TTeell NNoo..:: ________ MMoobbiillee NNoo..:: FFaaxx NNoo..:: ____ EE--mmaaiill ______________ ____________

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eexxeerrcciissee aallll aaccttiioonnss nneecceessssaarryy ttoo mmaaiinnttaaiinn tthhee pprreessttiiggee ooff tthhee PPhhiilliippppiinneess iinn ggeenneerraall aanndd tthhee BBooyy SSccoouuttss ooff tthhee PPhhiilliippppiinneess iinn

ppaarrttiiccuullaarr..

AApppplliiccaanntt’’ss SSiiggnnaattuurree ______________

DDaattee ____// // ____((dddd//mmmm//yyyy))

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

HHEEAALLTTHH DDEETTAAIILLSS

NNaammee:: ______________________________________________________________________________________ LLooccaall CCoouunncciill:: __________________________________________________________________

SSppeecciiaall HHeeaalltthh PPrroobblleemm ((DDoo yyoouu hhaavvee aannyy iillllnneessss ooff tthhee ffoolllloowwiinngg??))

HHeeaarrtt ddiisseeaassee HHaayy ffeevveerr DDiiaabbeettiicc HHyyppeerrtteennssiioonn FFaaiinnttiinngg

HHaaeemmoopphhiilliiaa AAsstthhmmaa EEppiilleeppttiicc SSlleeeepp WWaallkkiinngg AAuuttiissmm

AAnnyy ootthheerr AAlllleerrggiieess ________________

AAnnyy pphhyyssiiccaall ddiissaabbiilliittyy ________________

OOtthheerrss ((pplleeaassee ssppeecciiffyy)) ________________

RReeccoommmmeennddaattiioonn aanndd//oorr rreessttrriiccttiioonnss ((iiff nnoonnee,, ssoo ssttaattee)):: __________________________________________________________________________________________________________________________

PPhhyyssiicciiaann ((SSiiggnnaattuurree oovveerr PPrriinntteedd NNaammee))::____________________________________________________________________________ LLiicceennssee NNoo..:: ______________________________________

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AAPPPPRROOVVAALL OOFF PPAARREENNTTSS OORR GGUUAARRDDIIAANN

((ffoorr aapppplliiccaattiioonnss ooff mmiinnoorr aaggee))

WWee hheerreebbyy aapppprroovvee tthhiiss aapppplliiccaattiioonn aanndd cceerrttiiffyy ttoo iittss ccoorrrreeccttnneessss.. IInn ccoonnssiiddeerraattiioonn ooff tthhee bbeenneeffiittss ttoo bbee ddeerriivveedd,, wwee

eexxpprreessssllyy wwaaiivvee aannyy aanndd aallll ccllaaiimmss aaggaaiinn tthhee BBooyy SSccoouuttss ooff tthhee PPhhiilliippppiinneess oorr iittss rreepprreesseennttaattiivveess oonn aaccccoouunntt ooff aannyy iinncciiddeenntt oorr iinnjjuurryy

oorr ddaammaaggee ttoo ppeerrssoonnaall pprrooppeerrttyy tthhaatt mmaayy ooccccuurr bbeeyyoonndd tthhee ccoonnttrrooll ooff tthhee CCoonnttiinnggeenntt OOffffiicciiaallss//BBSSPP pprroovviiddeedd aaddeeqquuaattee ssaaffeettyy

mmeeaassuurreess aanndd pprreeccaauuttiioonnss hhaavvee bbeeeenn iinnssttiittuutteedd iinn ccoonnnneeccttiioonn wwiitthh tthhee ppaarrttiicciippaattiioonn ooff SSccoouutt ________________________________________________________________

iinn tthhee ______________________________________________________________________________________________________..

WWee ffuurrtthheerr aaggrreeee ttoo hhaavvee ssaaiidd SSccoouutt mmeeeett tthhee hheeaalltthh rreeqquuiirreemmeennttss wwhhiicchh iinncclluuddeess hhiiss eexxaammiinnaattiioonn bbyy aa MMeeddiiccaall OOffffiicceerr wwhhoo

wwiillll uussee tthhee ffoorrmm pprroovviiddeedd bbyy tthhee NNaattiioonnaall OOffffiiccee,, BBSSPP,, ffoorr tthhiiss ppuurrppoossee aanndd oobbttaaiinn cceerrttiiffiiccaattiioonn ffrroomm sscchhooooll aauutthhoorriittiieess aatttteessttiinngg ttoo hhiiss

aaccaaddeemmiicc ssttaannddiinngg..

__________________________________________________________________ ________________________________________________________________

FFaatthheerr//GGuuaarrddiiaann MMootthheerr//GGuuaarrddiiaann

((ssiiggnnaattuurree oovveerr pprriinntteedd nnaammee)) ((ssiiggnnaattuurree oovveerr pprriinntteedd nnaammee))

____________________________________________________________

DDaattee

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AACCTTIIOONN OOFF TTHHEE LLOOCCAALL CCOOUUNNCCIILL

DDaattee::______________________________________

WWee hheerreebbyy cceerrttiiffyy tthhaatt tthhee aabboovvee aapppplliiccaanntt hhaass mmeett aallll tthhee rreeqquuiirreemmeennttss ffoorr ppaarrttiicciippaattiioonn iinn hhiiss SSccoouutt eevveenntt aass sseett ffoorrtthh bbyy

tthhee NNaattiioonnaall OOffffiiccee ooff tthhee BBooyy SSccoouuttss ooff tthhee PPhhiilliippppiinneess.. WWee hhaavvee ppeerrssoonnaallllyy iinntteerrvviieewweedd SSccoouutt __________________________________________________________

aanndd ffoouunndd hhiimm pphhyyssiiccaallllyy ffiitt aanndd qquuaalliiffiieedd ttoo bbee mmeemmbbeerr ooff tthhee BBSSPP CCoonnttiinnggeenntt.. HHee iiss ccuurrrreennttllyy rreeggiisstteerreedd aanndd oonn tthhee bbaassiiss ooff hhiiss

rreeccoorrdd ooff ssaattiissffaaccttoorryy SSccoouuttiinngg eexxppeerriieennccee aanndd hhiiss ccooooppeerraattiivvee aattttiittuutteedd ttoowwaarrddss hhiiss ffeellllooww SSccoouuttss//SSccoouutt LLeeaaddeerrss,, wwee rreeccoommmmeenndd hhiiss

aacccceeppttaannccee aass aa mmeemmbbeerr ooff tthhee PPhhiilliippppiinnee DDeelleeggaattiioonn..

__________________________________________________________________ ________________________________________________________________

TTrroooopp LLeeaaddeerr//OOuuttffiitt AAddvviissoorr IInnssttiittuuttiioonnaall HHeeaadd

__________________________________________________________________ ________________________________________________________________

CCoouunncciill SSccoouutt EExxeeccuuttiivvee CCoouunncciill CChhaaiirrmmaann

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AACCTTIIOONN OOFF TTHHEE RREEGGIIOONNAALL OOFFFFIICCEE

RReeccoommmmeennddiinngg AApppprroovvaall::

______________________________________________________________________ ____________________________________________

RReeggiioonnaall SSccoouutt DDiirreeccttoorr DDaattee

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AACCTTIIOONN OOFF TTHHEE NNAATTIIOONNAALL OOFFFFIICCEE

RReeccoommmmeennddiinngg AApppprroovvaall::

______________________________________________________________________ ____________________________________________

DDiirreeccttoorr,, FFiieelldd OOppeerraattiioonnss DDiivviissiioonn DDaattee

AApppprroovveedd::

______________________________________________________________________ ____________________________________________

OOffffiicceerr--IInn--CChhaarrggee//SSeeccrreettaarryy GGeenneerraall DDaattee

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NNOOTTEE:: PPlleeaassee rreettuurrnn tthhiiss ffoorrmm ttooggeetthheerr wwiitthh tthhee PPHHOOTTOOCCOOPPYY OOFF YYOOUURR PPHHIILLIIPPPPIINNEE PPAASSSSPPOORRTT aanndd ssuubbmmiitt ttoo tthhee BBooyy SSccoouuttss ooff tthhee PPhhiilliippppiinneess –– IInntteerrnnaattiioonnaall AAffffaaiirrss

SSeeccttiioonn,, FFiieelldd OOppeerraattiioonnss DDiivviissiioonn aatt 118811 NNaattiivviiddaadd AAllmmeeddaa--LLooppeezz SSttrreeeett,, EErrmmiittaa,, MMaanniillaa PPhhiilliippppiinneess oorr EEmmaaiill:: bbsspp@@ssccoouuttss..oorrgg..pphh..

RREEPPUUBBLLIICC OOFF TTHHEE PPHHIILLIIPPPPIINNEESS ))

CCIITTYY//PPRROOVVIINNCCEE )) SS..SS..

AAFFFFIIDDAAVVIITT OOFF SSUUPPPPOORRTT AANNDD CCOONNSSEENNTT

WWee,, ____________________________________________________________________________ aanndd __________________________________________________________________

bbootthh ooff lleeggaall aaggee,, mmaarrrriieedd//ssiinnggllee//wwiiddooww//wwiiddoowweerr.. FFiilliippiinnoo cciittiizzeennss aanndd wwiitthh ppoossttaall aaddddrreessss aatt

________________________________________________________________________ aanndd ________________________________________________________________________________________,,

rreessppeeccttiivveellyy,, hhaavviinngg bbeeeenn dduullyy sswwoorrnn ttoo iinn aaccccoorrddaannccee wwiitthh llaaww hheerreebbyy ddeeppoossee aanndd ssaayy::

TTHHAATT wwee aarree tthhee ppaarreennttss ooff ________________________________________________________________________________________ wwhhoo iiss//aarree

ggooiinngg ttoo ______________________________________________________________________________________________________ ffoorr aa ppeerriioodd ooff nnoott mmoorree tthhaann

______________________________________________________________________..

TTHHAATT tthhee ppuurrppoossee ooff tthhee ttrriipp ooff ____________________________________________________________________________________________________________

ttoo __________________________________________________________________________________ iiss ______________________________________________________________________________

aanndd tthhaatt wwee hhaavvee nnoo oobbjjeeccttiioonn ffoorr hhiiss//hheerr//tthheeiirr ssttaayy aabbrrooaadd;;

TTHHAATT wwee hheerreebbyy uunnddeerrttaakkee aanndd gguuaarraanntteeee ttoo aassssuummee aannyy aanndd aallll eexxppeennsseess wwhhiicchh mmaayy bbee iinnccuurrrreedd

bbyy hhiimm//hheerr//tthheemm dduurriinngg hhiiss//hheerr//tthheeiirr ssttaayy aabbrrooaadd;;

TTHHAATT tthhiiss aaffffiiddaavviitt iiss bbeeiinngg eexxeeccuutteedd ffoorr tthhee ppuurrppoossee ooff iinnffoorrmmiinngg tthhee pprrooppeerr aauutthhoorriittiieess ccoonncceerrnneedd

oouurr wwiilllliinnggnneessss aanndd aabbiilliittyy ttoo ssuuppppoorrtt oouurr ssoonn’’ss//ddaauugghhtteerr’’ss//cchhiillddrreenn’’ss ttrriipp aabbrrooaadd..

FFUURRTTHHEERR AAFFFFIIAANNTT SSAAYYEETTHH NNAAUUGGHHTT..

____________________________________________________________________ ________________________________________________________________

FFaatthheerr MMootthheerr

SSUUBBSSCCRRIIBBEEDD AANNDD SSWWOORRNN ttoo bbeeffoorree mmee tthhiiss ________________________ ddaayy ooff ______________________________________________

2200____ aatt tthhee CCiittyy//PPrroovviinnccee ooff __________________________________________________ aaffffiiaannttss wwiitthh tthheeiirr RReessiiddeennccee CCeerrttiiffiiccaattee NNoo..

__________________________________ iissssuueedd aatt __________________________________________________________________ oonn ______________________________________________

aanndd NNoo.. ____________________________________ iissssuueedd aatt ____________________________________________________ oonn ____________________________________________

rreessppeeccttiivveellyy..

NNOOTTAARRYY PPUUBBLLIICC

UUnnttiill ________________________________________

DDoocc.. NNoo.. __________________________________ PPTTRR NNoo..

PPaaggee NNoo.. ________________________________ DDaattee

BBooookk NNoo.. ________________________________ PPllaaccee

SSeerriieess NNoo.. ______________________________ TTIINN