BSP FORM No.

6-03
(Revised 30 Jan 2020) NATIONAL OFFICE COPY
BOY SCOUTS OF THE PHILIPPINES
181 Natividad Almeda-Lopez Street, Ermita, Manila 1000

APPLICATION FOR ADULT REGISTRATION

AAR No.

GREGORIA R MARRIED
F Civil Status: ____________
Name: ____________________________________________________________
ACAYANG Sex: _____
Surname First Name M.I
2YRS Membership Card No. ____________________
Tenure in Scouting _______ Expiration Date _________________
To serve as: _____________________________________________________________________________
OUTFIT ADVISER 467
________
Scouting Position Unit No.
ORIENTAL MINDORO
PAG-ASA NATIONAL HIGH SCHOOL
____________________________________________________________ ____________________________________
Sponsoring Institution Council
BAGONG BAYAN 2, BONGABONG, ORIENTAL MINDORO
Mailing Address: _________________________________________________________________________________
Date of Birth: ______________________
MAY 09, 1986 Place of Birth: ________________________
BONGABONG CATHOLIC
Religion: _________________
Profession/Occupation: _________________________
TEACHING Position/Title: ______________________________________
TEACHER III
Other Affiliations: _________________________________________________ Registration status: New Reregistering

SAFE FROM HARM

World Scouting emphasizes that the achievement of Scouting’s Mission makes it essential for the Movement to
provide young people with a “safe passage” based on respect for their integrity and their right to develop in a non-
constraining environment. The Boy Scouts of the Philippines implements “Safe from Harm” on the conviction
that all adults and children have a right NOT to be abused. This is a fundamental human right. Abuse can take the
form of bullying, physical abuse, emotional abuse, neglect, sexual abuse and exploitation. It is important to note
that young people can suffer from one or a combination of these forms of abuse. Abuse can take place at home,
at school or anywhere young people spend time. In the great majority of cases, the abuser is someone the young
person knows, such as a parent, teacher, relative, leader or friend. The main objective is to ensure that no one will
be exposed to abuse. Good child protection practice means making sure that everyone is aware of signs of potential
abuse. It is based upon the Declaration on the Rights of the Child and Human Rights.
I hereby commit and fully subscribe to the existing Safe From Harm Policy of the Boy Scouts of the Philippines,
and that I hereby absolve and free the BSP from any liability arising from any of my acts contrary to the policy.
I hereby accept that the BSP may immediately revoke my registration as an adult leader upon violation of such
policy.
GREGORIA R ACAYANG
_______________________________
Signature Over Printed Name

REGISTRATION FEES LOCAL COUNCIL OFFICE ACTION

Please check one; RATE Processed : ______________________________ _____________
Registration Officer Date
LCEB Members 500.00
UL/AUL 60.00 Approved : _______________________________ ____________
Council Scout Executive Date
Lay Leaders 100.00
REGIONAL OFFICE ACTION
AMOUNT PAID _______________
Checked : _____________________________________ ______________
Paid Under OR. No. __________________ Date _______________ Registration Officer Date
 BSP FORM No. 6-03
(Revised 30 Jan 2020) REGIONAL OFFICE COPY
BOY SCOUTS OF THE PHILIPPINES
181 Natividad Almeda-Lopez Street, Ermita, Manila 1000

APPLICATION FOR ADULT REGISTRATION

AAR No.

Name: ____________________________________________________________ Sex: _____ Civil Status: ____________

Surname First Name M.I
Tenure in Scouting _______ Membership Card No. ____________________ Expiration Date _________________
To serve as: _____________________________________________________________________________ ________
Scouting Position Unit No.

____________________________________________________________ ____________________________________
Sponsoring Institution Council
Mailing Address: _________________________________________________________________________________
Date of Birth: ______________________ Place of Birth: ________________________ Religion: _________________
Profession/Occupation: _________________________ Position/Title: ______________________________________
Other Affiliations: _________________________________________________ Registration status: New Reregistering

SAFE FROM HARM

World Scouting emphasizes that the achievement of Scouting’s Mission makes it essential for the Movement to
provide young people with a “safe passage” based on respect for their integrity and their right to develop in a non-
constraining environment. The Boy Scouts of the Philippines implements “Safe from Harm” on the conviction
that all adults and children have a right NOT to be abused. This is a fundamental human right. Abuse can take the
form of bullying, physical abuse, emotional abuse, neglect, sexual abuse and exploitation. It is important to note
that young people can suffer from one or a combination of these forms of abuse. Abuse can take place at home,
at school or anywhere young people spend time. In the great majority of cases, the abuser is someone the young
person knows, such as a parent, teacher, relative, leader or friend. The main objective is to ensure that no one will
be exposed to abuse. Good child protection practice means making sure that everyone is aware of signs of potential
abuse. It is based upon the Declaration on the Rights of the Child and Human Rights.
I hereby commit and fully subscribe to the existing Safe From Harm Policy of the Boy Scouts of the Philippines,
and that I hereby absolve and free the BSP from any liability arising from any of my acts contrary to the policy.
I hereby accept that the BSP may immediately revoke my registration as an adult leader upon violation of such
policy.
_______________________________
Signature Over Printed Name

REGISTRATION FEES LOCAL COUNCIL OFFICE ACTION

Please check one; RATE Processed : ______________________________ _____________
Registration Officer Date
LCEB Members 500.00
UL/AUL 60.00 Approved : _______________________________ ____________
Council Scout Executive Date
Lay Leaders 100.00
REGIONAL OFFICE ACTION
AMOUNT PAID _______________
Checked : _____________________________________ ______________
Paid Under OR. No. __________________ Date _______________ Registration Officer Date
 BSP FORM No. 6-03
(Revised 30 Jan 2020) LOCAL COUNCIL COPY
BOY SCOUTS OF THE PHILIPPINES
181 Natividad Almeda-Lopez Street, Ermita, Manila 1000

APPLICATION FOR ADULT REGISTRATION

AAR No.

Name: ____________________________________________________________ Sex: _____ Civil Status: ____________

Surname First Name M.I
Tenure in Scouting _______ Membership Card No. ____________________ Expiration Date _________________
To serve as: _____________________________________________________________________________ ________
Scouting Position Unit No.

____________________________________________________________ ____________________________________
Sponsoring Institution Council
Mailing Address: _________________________________________________________________________________
Date of Birth: ______________________ Place of Birth: ________________________ Religion: _________________
Profession/Occupation: _________________________ Position/Title: ______________________________________
Other Affiliations: _________________________________________________ Registration status: New Reregistering

SAFE FROM HARM

World Scouting emphasizes that the achievement of Scouting’s Mission makes it essential for the Movement to
provide young people with a “safe passage” based on respect for their integrity and their right to develop in a non-
constraining environment. The Boy Scouts of the Philippines implements “Safe from Harm” on the conviction
that all adults and children have a right NOT to be abused. This is a fundamental human right. Abuse can take the
form of bullying, physical abuse, emotional abuse, neglect, sexual abuse and exploitation. It is important to note
that young people can suffer from one or a combination of these forms of abuse. Abuse can take place at home,
at school or anywhere young people spend time. In the great majority of cases, the abuser is someone the young
person knows, such as a parent, teacher, relative, leader or friend. The main objective is to ensure that no one will
be exposed to abuse. Good child protection practice means making sure that everyone is aware of signs of potential
abuse. It is based upon the Declaration on the Rights of the Child and Human Rights.
I hereby commit and fully subscribe to the existing Safe From Harm Policy of the Boy Scouts of the Philippines,
and that I hereby absolve and free the BSP from any liability arising from any of my acts contrary to the policy.
I hereby accept that the BSP may immediately revoke my registration as an adult leader upon violation of such
policy.
_______________________________
Signature Over Printed Name

REGISTRATION FEES LOCAL COUNCIL OFFICE ACTION

Please check one; RATE Processed : ______________________________ _____________
Registration Officer Date
LCEB Members 500.00
UL/AUL 60.00 Approved : _______________________________ ____________
Council Scout Executive Date
Lay Leaders 100.00
REGIONAL OFFICE ACTION
AMOUNT PAID _______________
Checked : _____________________________________ ______________
Paid Under OR. No. __________________ Date _______________ Registration Officer Date
 BSP FORM No. 6-03
(Revised 30 Jan 2020) SPONSORING INSTITUTION COPY
BOY SCOUTS OF THE PHILIPPINES
181 Natividad Almeda-Lopez Street, Ermita, Manila 1000

APPLICATION FOR ADULT REGISTRATION

AAR No.

Name: ____________________________________________________________ Sex: _____ Civil Status: ____________

Surname First Name M.I
Tenure in Scouting _______ Membership Card No. ____________________ Expiration Date _________________
To serve as: _____________________________________________________________________________ ________
Scouting Position Unit No.

____________________________________________________________ ____________________________________
Sponsoring Institution Council
Mailing Address: _________________________________________________________________________________
Date of Birth: ______________________ Place of Birth: ________________________ Religion: _________________
Profession/Occupation: _________________________ Position/Title: ______________________________________
Other Affiliations: _________________________________________________ Registration status: New Reregistering

SAFE FROM HARM

World Scouting emphasizes that the achievement of Scouting’s Mission makes it essential for the Movement to
provide young people with a “safe passage” based on respect for their integrity and their right to develop in a non-
constraining environment. The Boy Scouts of the Philippines implements “Safe from Harm” on the conviction
that all adults and children have a right NOT to be abused. This is a fundamental human right. Abuse can take the
form of bullying, physical abuse, emotional abuse, neglect, sexual abuse and exploitation. It is important to note
that young people can suffer from one or a combination of these forms of abuse. Abuse can take place at home,
at school or anywhere young people spend time. In the great majority of cases, the abuser is someone the young
person knows, such as a parent, teacher, relative, leader or friend. The main objective is to ensure that no one will
be exposed to abuse. Good child protection practice means making sure that everyone is aware of signs of potential
abuse. It is based upon the Declaration on the Rights of the Child and Human Rights.
I hereby commit and fully subscribe to the existing Safe From Harm Policy of the Boy Scouts of the Philippines,
and that I hereby absolve and free the BSP from any liability arising from any of my acts contrary to the policy.
I hereby accept that the BSP may immediately revoke my registration as an adult leader upon violation of such
policy.
_______________________________
Signature Over Printed Name

REGISTRATION FEES LOCAL COUNCIL OFFICE ACTION

Please check one; RATE Processed : ______________________________ _____________
Registration Officer Date
LCEB Members 500.00
UL/AUL 60.00 Approved : _______________________________ ____________
Council Scout Executive Date
Lay Leaders 100.00
REGIONAL OFFICE ACTION
AMOUNT PAID _______________
Checked : _____________________________________ ______________
Paid Under OR. No. __________________ Date _______________ Registration Officer Date