Synergy registration form


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Synergy registration form

  1. 1. THE AKSIS 101 CULMINATING ACTIVITY and CAMP 2011 November 5-6, 2011 at Camp Explore, Antipolo, RizalDear AKSIS Member, With a big smile, we proudly present you SYNERGY, the Culminating Activity for the first semester’s AKSIS101. We thank you for expressing your interest in participating to this event. We will be formally welcoming thenew members to the club, and strengthen the bonds between members. By the end of this activity, you’ll findyourself well-acquainted with your club mates, your officers, and most importantly, with the AKSIS family. For November 5-6, 2011, we will be at the Camp Explore’s Forest Camp, surrounded by the Sierra MadreMountains and Marikina Watershed of Mt.Purro, Nature Reserve. With nature at its purest, the participants areexpected to have a weekend well-spent for we have prepared a multitude of fun and engaging activities that at thesame time will help them accomplish the objectives of this activity. Feel free to learn more about the venuethrough their website: In your hands is the registration packet. To reserve your slot, kindly accomplish the form and pay theregistration fee of P1,300 (inclusive of transportation, three meals and two snacks, and cottage style lodging) tothe AKSIS core team on October 26 (4:30-5:30PM) or October 27 (3:30-5:30PM) at the PSHS-MC, back lobby area(near the cafeteria). Our team will be there to entertain further questions and present you with the final briefingand guidelines upon payment. If you will be unable to pay the full amount right away, you may pay half (P650 -P700) to reserve and the balance on November 5. Please make all checks payable to cash. Thank you for your unwavering support. We hope to have your presence in this forthcoming activity, aswe build towards a meaningful and fun-packed second semester of the school year. Ryan B. Misola AKSIS President Noted by: Vladimir S. Lopez AKSIS Adviser For questions and clarifications, you may contact the following: MR. VLADIMIR LOPEZ (Adviser) – 0917-986-8664, RYAN MISOLA (AKSIS President) – 09056792800, NICOLE ROCAFORT (AKSIS SECRETARY, Committee Head) – 0906-297-3043 Or post in our AKSIS s/y 2011-2012 Facebook Group
  2. 2. REGISTRATION FORM (Print out. Fill up. Submit on October 26 or 27, along with your payment. )FIRST THINGS FIRST Full Name Nickname Year and Section Mobile Number Email Address Home Address, LandlineOLD MEMBERS Duration (SINCE WHEN WERE YOU A MEMBER?) Participation* ARM Rate the Club’s Activity* SWITCH ARMS? (IF YES, TO WHICH ARM?)NEW MEMBERS – WELCOME TO AKSIS! Rate the Club’s Activity* Preferred Arm List of AKSIS Friends Expectations this S/Y *For Participation: VA (very active), SA (somewhat active), SI (somewhat inactive), VI (very inactive)Parent’s PermitI hereby allow my son/daughter to participate in SYNERGY this November 5-6, 2011 at Camp Explore, Antipolo,Rizal, to be hosted by AKSIS, the social science club of the PSHS. I also certify that my son/daughter is physicallyfit and ready to join a summer camp and participate in all its outdoor activities that will include challengingterrain, obstacle courses, slippery surfaces, mud, and water.I will also be my son’s/daughter’s emergency contact. My details (mobile/landline/e-mail) are__________________________________________________________________________________________. Duly signed, ______________________________________ (printed name and signature) ------------------------------------------------------------------------------------------------------------------------------------------ EMERGENCY CONTACT INFORMATION (feel free to tear off this portion) Dr. Cristina Cristobal (SSD Chief) – (02)9240661 Mr. Vladimir Lopez (AKSIS Adviser) – 017-986-8664 Ryan Misola (AKSIS President) – 0905-679-2800 Nicole Rocafort (AKSIS Sec., Program Head) – 0906-297-3043 Ms. Kit Malvar Llamas (Camp Director) – 0917-898-2155