BSP FORM No.

6-03 (Revised 30 Jan 2020) 181 Natividad Almeda-Lopez Street, FOR ADULT REGISTRATION

BOY SCOUTS OF THE Ermita, Manila 1000 APPLICATION NATIONAL OFFICE COPY AAR No.
PHILIPPINES

Name: REYES, JEAN FRANCIS B. Sex: FEMALE Civil Status: MARRIED

Surname First Name M.I
Tenure in Scouting _______ Membership Card No. ____________________ Expiration Date _________________ To
serve as: _____________________________________________________________________________ ________
Scouting Position Unit No.
SOUTHVILLE IV NATIONAL HIGH SCHOOL____________________________
Sponsoring Institution Council
Mailing Address: BLK 9 LOT 4 DODGE STREET GARDEN VILLAS 1 BRGY LABAS CITY OF STA ROSA LAGUNA
Date of Birth: 2-2-1982 Place of Birth: Tarragona Davao Oriental Religion: Born Again Christian
Profession/Occupation: Teaching Position/Title: TEACHER I
Other Affiliations: ______________ SAFE FROM HARM

____________________REREGISTERING_______________ Registration status: New Reregisterin

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.
JEAN FRANCIS B. REYES
Signature Over Printed Name

REGISTRATION FEES LCEB Members 500.00

UL/AUL 60.00
Please check one; RATE
Lay Leaders 100.00
AMOUNT PAID _______________ Paid Under OR. No.

__________________ Date _______________

LOCAL COUNCIL OFFICE ACTION

Processed : ______________________________ _____________
Registration Officer Date

Approved : _______________________________ ____________ Council

Scout Executive Date

REGIONAL OFFICE ACTION

Checked : _____________________________________ ______________

Registration Officer Date
 BSP FORM No. 6-03 (Revised 30 Jan 2020) 181 Natividad Almeda-Lopez Street, FOR ADULT REGISTRATION

BOY SCOUTS OF THE Ermita, Manila 1000 APPLICATION REGIONAL OFFICE COPY AAR No.
PHILIPPINES

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: _ SAFE FROM HARM

________________________________________________ Registration status: New Reregistering

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 Please check one; RATE

 LCEB Members 500.00 Processed : ______________________________ _____________
Registration Officer Date
UL/AUL 60.00
Lay Leaders 100.00 Approved : _______________________________ ____________ Council
Scout Executive Date
AMOUNT PAID _______________ Paid Under OR. No.
REGIONAL OFFICE ACTION
__________________ Date _______________
Checked : _____________________________________ ______________
Registration Officer Date
LOCAL COUNCIL OFFICE ACTION
BSP FORM No. 6-03 (Revised 30 Jan 2020) 181 Natividad Almeda-Lopez Street, FOR ADULT REGISTRATION

BOY SCOUTS OF THE Ermita, Manila 1000 APPLICATION LOCAL COUNCIL COPY AAR No.
PHILIPPINES

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: _ SAFE FROM HARM

________________________________________________ Registration status: New Reregistering

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
Approved : _______________________________ ____________ Council
UL/AUL 60.00
Scout Executive Date
Lay Leaders 100.00
REGIONAL OFFICE ACTION
AMOUNT PAID _______________ Paid Under OR. No.
Checked : _____________________________________ ______________
__________________ Date _______________ Registration Officer Date
BSP FORM No. 6-03 (Revised 30 Jan 2020) PHILIPPINES
SPONSORING INSTITUTION COPY
BOY SCOUTS OF THE

181 Natividad Almeda-Lopez Street, Ermita, Manila 1000 AAR No.

APPLICATION FOR ADULT REGISTRATION

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: _ SAFE FROM HARM

________________________________________________ Registration status: New Reregistering

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
Please check one; RATE

LCEB Members 500.00

UL/AUL 60.00
Lay Leaders 100.00

AMOUNT PAID _______________ Paid Under OR. No.

__________________ Date _______________

LOCAL COUNCIL OFFICE ACTION

Processed : ______________________________ _____________
Registration Officer Date

Approved : _______________________________ ____________ Council

Scout Executive Date

REGIONAL OFFICE ACTION

Checked : _____________________________________ ______________

Registration Officer Date