1. COMMISSION ON YOUTH
ENVIRONMENTAL IMMERSION LEVEL UPFORM 1
GENERAL INFORMATION
NAME:
LAST FIRST MIDDLE
NICKNAME:
ADDRESS:
HOUSE NO./ST. BARANGAY MUNICIPALITY PROVINCE
KAPILYA/PARISH:
OCCUPATION: BIRTHDAY: GENDER: CONTACT NO.: CLUSTER:
SCHOLASTIC BACKGROUND
YEAR/GRADE LEVEL: SECTION/COURSE: SCHOOL:
ORGANIZATIONAL BACKGROUND:
1.____________________________________________
2.____________________________________________
3.____________________________________________
POSITION:
_____________
_____________
_____________
YEAR:
_____________
_____________
_____________
MOTTO:
CONFIRMATION:
I, the undersigned confirmed to attend and participate in the ENVIRONMENTAL
IMMERSION LEVEL UP on May 8-12, 2014 at Dinapa, Castilla, Sorsogon. Thus, I affirm to the
vision and commitment of the ADVOCACY FOR THE ENVIRONMENT that this activity will
develop my environmental awareness to become more active for the environment and the welfare of the
community.
_____________________________________
SIGNATURE OVER PRINTED NAME
PAID IN FULL: __________ PAID IN PARTIAL: ______
AMOUNT PAID: __________ ACKNOWLEDGMENT Receipt No.: ____________
Verified:
CHERRY SALOMON CHARMAINE F. ABRIGO
Treasurer Chairman, Committee on Registration
REGISTRATION NO.:__________________
REPLY SLIP/PARENTS PERMIT
THE ORGANIZERS
We believe in the endeavor of the ADVOCACY FOR THE ENVIRONMENT – YOUTH MINISTRY
that the participation of my son/daughter __________________________ in the ENVIRONMENTAL
IMMERSION LEVEL UP will help him/her enhance his/her competence as a member of the
community, and thus we permit his/her participation.
We also understand that the organizers secure every possible means to make his/hers stay safe and
worthwhile, thus the camp organizer will not be held liable of any untoward incidents that may happen
beyond his/her control and responsibility.
Very truly yours,
_________________________________ _______________________________
Signature over printed name of parent Contact No. of parent