BARANGAY diin nagpuyo: Republic of the Philippines Province of Agusan del Norte CITY OF CABADBARAN ( isa lang ka Barangay ang isulat sa ubos) Sports, Music, Arts and Recreational Training Summer Program (S.M.A.R.T. Summer Program - Year 5) APPLICATION FORM EVENT 1ST CHOICE: __________________ Date of Application:____________________ PART 1. Personal Information: 2ND CHOICE:__________________ Name of Applicant:_______________________________________________________ (Family Name) (First Name) Gender (pls. check):___Male___Female Age:______ (Middle Initial) Landline/Mobile Contact Number: _________________________ E-mail/Facebook Account( if any): ____________________________________________________________ Size of T-Shirt (GRANDSLER Brand) Religion:__________________________________ 3RD CHOICE:__________________ note: applicant is only entitled to the events he/she indicated above in such order of priority. In case all events are CLOSED, he/she shall be placed on WAITLIST and may be registered to any remaining OPEN events after cut-off time. Complete Address: _____________________________________________________________________ (Purok/Barangay) (Street) (City/Municipality) Name of School: _________________________________________________________________________ Grade/Year Level (if studying): _________________ Event enrolled last year: _________________________ Contact Person in case of emergency: ____________________________ Contact No: __________________ PART II. Duties and Responsibilities of a S.M.A.R.T. Youth Summer Program Applicant: “ I pledge commitment to perform my duties and responsibilities under the said program and undertake that I will completely attend all the sessions under my assigned program and properly inform my trainer/facilitator in the event that I will be absent for excusable reasons otherwise my unexcused absences for three (3) consecutive days shall be a cause for my disqualification and be blacklisted” ______________________________ (Signature over printed name) ------------------------------------------------------------------------------------------------------------------------ PARENTAL CONSENT / WAIVER I/We hereby allow our son/daughter, ____________________________________________ to participate in the S.M.A.R.T. Year 5 Summer Program (Sports, Music, Arts and Recreational Training) and submit to the rules and regulations of the same. Furthermore, I/we hold the organizers free from any liability in case of accidental injury to our child incurred during the ordinary course of the summer training program or because of my child’s negligence. ______________________________ Name and Signature of Mother/Guardian ______________________________ Name and Signature of the Father/Guardian REGISTRATION PROCEDURE  1. Mangayo ug Application forms sa: (1) inyong Barangay Ofiice; (2) Community Affairs Office sa City Hall or (3) Mag-download sa www.cabadbarantoday.gov.ph or www.facebook.com/ CabadbaranCityOfficialpage/ og i-print. 2. Tubagon tanan gipangayo nga impormasyon sa Application Form og pirmahan sa bata og sa iyang ginikanan o guardian. 3. Dad-on ang Application Form nga pirmado na ngadto sa Registration Center sa adlaw nga na-schedule. 4. Sa Registration Center, mangayo og Priority Number (PN) sa In-Charge. 5. Kun tawagon na ang Priority Number, muduol sa Registration Table og i-submit ang Priority Number og ang Application Form. 6. Sa mga bata nga adunay Transportation Allowance: Pirmahan ang “Itinerary of Travel” og “ “Certificate of Travel Completed” 7. Sa mga madawat sa Sports Events, Hiphop og Contemporary: muduol sa Medic Table para sa Health Check-up. 8. Ihatag sa Exit Table ang natatakan na nga Application Form og maghulat sa Confirmation Slip nga ihatag. END ENROLMENT CONFIRMATION SLIP Name: ____________________________________ Event : _________________________ Barangay: _________________________________ Trainee No: ( to be filled-up by the Registrar) ( give this Slip to the Trainor / Facilitator during the SMART 2015 Orientation & Opening Ceremony)