PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent to the participation of my son __________________ of
______________– Leonides S. Virata Memorial School,in the BSP Councilwide Island Jamborette at PSU Cuyo
Island, Palawan on October 25-November 2, 2013

I/We have considered the benefits that my son will derive from his participation in this activity with the
understanding that due care and precaution will be observed to ensure the comfort and safety of the delegation and that
LSVMS, DepEd and BSP Palawan-Puerto Princesa Council employees and personnel may not be held responsible for any
untoward incident that may happen beyond their control.

_________________________________________________
Signature of Parents / Guardian over Printed Name

Noted by:
Noeme G. Benetua
Principal
------------------------------------------------------------------------------------------------------------------------------------------------------

MEDICAL CERTIFICATE
__________________________
Date
To Whom It May Concern:

This is to certify that I have personally examined ____________________________________________________

Name
.
age ____________ sex ___________ born on __________________________________ and have found that he / she is
physically fit during the time of examination, to join the BSP Councilwide Island Jamborette.

Physical Examination

Date examined: _______________________

Height: _____________________ Weight: __________________ Blood Pressure: _____________

Pulse, Resting: _____________________ Respiratory Rate: _________________
Other Remarks: ___________________________________________________________________________________
___________________________________________________________________________________
____________________________________________________________________________________

______________________________
Physical / Medical Officer
(Signature over printed name)
License No. _____________
PTR: __________________
Date: _________________
Things to Bring Things to Bring
 Island Scout Jamborette
PSU - Cuyo Island, Palawan
October 25-November 2, 2013
To PPC - October 25, 2013 @ 3:00 PM
assembly area: Gate 1, School
Ropes for knot tying
Pocket Money
Php 300.00 - LSVMS Contingency Fund
Php 400.00- Camp Registration Fee
Php 1,000.00 - Fare RTN-PPC/ PPC-RTN
Rubber Shoes, & Slippers
2 black Socks
Neckerchief with Carabao Slide
6 T-Shirts, 4 Shorts, 8 Underwears
Complete P.E. Uniform
1 pair of pants, jacket
flashlight (with battery or rechargable)
plate, spoon, fork, drinking container
special medicines & OFF Lotion
bath towel & face towel
malong/blanket
1 small notebook & ballpen
bath soap, shampoo, deodorant
toothbrush, toothpaste
Sir Jay's CP Number: 09277047189
ALL THINGS MUST BE IN ONE BACK PACK ONLY
Island Scout Jamborette
PSU - Cuyo Island, Palawan
October 25-November 2, 2013
To PPC - October 25, 2013 @ 3:00 PM
assembly area: Gate 1, School
Ropes for knot tying
Pocket Money
Php 300.00 - LSVMS Contingency Fund
Php 400.00- Camp Registration Fee
Php 1,000.00 - Fare RTN-PPC/ PPC-RTN
Rubber Shoes, & Slippers
2 black Socks
Neckerchief with Carabao Slide
6 T-Shirts, 4 Shorts, 8 Underwears
Complete P.E. Uniform
1 pair of pants, jacket
flashlight (with battery or rechargable)
plate, spoon, fork, drinking container
special medicines & OFF Lotion
bath towel & face towel
malong/blanket
1 small notebook & ballpen
bath soap, shampoo, deodorant
toothbrush, toothpaste
Sir Jay's CP Number: 09277047189
ALL THINGS MUST BE IN ONE BACK PACK ONLY