Page 18

Registration
Form
 


GENERAL
INFORMATION
(FOR
ALL
CLUB
MEMBERS)

 NAME:
__________________________________________Sex:
_______________

 Club.
_________________________________
Church:
______________________
 Conference/Mission:
_________________________Union:____________________

 
 PATHFINDER
INFORMATION:

 Date
of
birth:
_______/____/_____/


Place
of
birth:__________________________

 Number
of
Camporees
you
participated
in:
___________

 Weight
(kg)
_________
Height:
__________
Blood
Type:
_____________________
 Address:
________________________________________________Tel.________________

 
 IF
YOU
ARE
NOT
A
PATHFINDER,
FILL
IN
THIS
INFORMATION:

 Time
as
a
Master
Guide:
_______
Number
of
Camporee
you
attended:
_________

 What
is
your
function
in
the
club:
(mark
the
option)

 Director,
Associate,
Secretary,
Chaplain,
Instructor,
Counselor,
Captain,
Unit
Secretary,
Other:
 _______________________________________

 Address:
____________________________________________Tel:
____________

 
 HEALTH
INFORMATION

 Do
you
suffer
from
some
kind
of
sickness
that
needs
special
treatment?
YES__
NO
__
 If
your
answer
is
YES,
indicate
what
it
is
and
what
is
required:
 ___________________________________________________________________

 ___________________________________________________________________

 Are
you
bringing
along
some
kind
of
medical
treatment?
 ___________________________________________________________________

 Are
you
taking
any
special
medication?
____

Which
one?
____________________
 How
frequent
are
you
taking
it?
___________________________________________________________________

 Allergies:
YES
___
NO
___
to
what,
if
you
answer
positively____________________

 Which
medicine
should
be
used?
___________________________________________________________________
 ___________________________________________________________________

 
 Are
you
allergic
to
some
kind
of
medication?____

If
so
which
one?
 ___________________________________________________________________

 
 Observations:
The
director
of
the
Club
has
to
give
a
copy
of
this
form
to
each
Pathfinder
and
it
should
be
 kept
in
your
folder
and
a
copy
should
be
given
to
the
Conference/Mission.


Bulletin 3 - English  

Bulletin 3 Inter-American Division Camporee

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