RegForm2015

FORM 3

Pambansang Kapisanan ng mga Kabataan Samahan ng Agham (Philippine Society of Youth Science Clubs), Inc.

2015 National Youth Science, Technology, and Environment Summer Camp

TRANSPRISM: FINDING HUE IN THE SPECTRUM OF CANDELLA
July 26- 29, 2015 | Sarabia Manor Hotel and Convention Center, Iloilo City, Iloilo
SCHOOL INFORMATION
School Name: ______________________________________________
School Address: ____________________________________________
School Contact Number/s: __________________________________________
Teacher

Student

Year Level:

STAPLE 2PCS
1x1 PICTURES
(With full name at the back of each photo)

PERSONAL INFORMATION
Name:
LAST NAME

FIRST NAME

Nickname: _______________

Gender:

Male

MI

Female Birthday:

Contact #: ____________
MONTH

DAY

YEAR

Home Address: ________________________________________________________________ Email: _____________________
SPECIAL MEDICATION
NEEDED

FOOD RESTRICTIONS
Pork
Fish
Chicken
Mollusc
Beef
Goat

IN CASE OF EMERGENCY, please contact:
Name : __________________________________________
Relationship: _____________Contact No.:_____________

Crustacean (crabs, etc)
Dinuguan/Sisig

Address: ________________________________________

Others: ____________________
JOINING COMPETITIONS? (Check all that applies)

Entertainment Night
Poster Making Contest
Essay Writing Contest

School Quiz Contest
Sci-Research Congress
Pasalubong Festival

NYSTESC 2015 SHIRT SIZE
NYSTESC 2014 Shirt Size (Please refer to the Comparative Shirt Size at the back of this form. Also, please note that shirt sizes will only be guaranteed if you submit your registration form on or before June 27, 2015)

XS

S

M

L

XL

XXL

ARE YOU AN AWARDEE?

Laking PSYSC Awardee (joined at least 1 CSIW and 2 CAMP)
Loyalty Awardee
(joined 3 consecutive CAMPs, including this year)
Golden Awardee
(joined 4 consecutive CAMPs, including this year)
MEDICAL CERTIFICATE

I hereby certify that I have examined ________________________
___________________ and found