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									                                          Province of North Cotabato
                                                Kidapawan City
                                              Office of the Mayor
                                     MT. APO CLIMB APPLICATION
         ________________________________________________________________________
Personal Data (print and or mark clearly)
Name ______________ _________________ ___ _________ Status [ ] Single
           Last Name            First Name         MI     NName        [ ] Married
                                                                       [ ] Separated
                                                                       [ ] Widow/Widower
Birth Date ____________ Age____ Gender _____ Blood Type ___
             Month/Date/Year
Address ___________________________________ E-mail Add: __________________
                   No. Street, City/Municipality
Contact No. _____________             ______________ ____________ Nationality: [ ] Filipino
                   Landline No.       Cellular Phone No.       Fax No.            [ ] Foreigner
Place of Origin: [ ] North Cotabato [ ] Outside N. Cot but w/in Reg. 12 [ ] Outside R12 but w/in Mindanao
                 [ ] Visayas Areas [ ] Luzon Areas
Educational Attainment [ ] Professional [ ] College Student [ ] Highschool Student
                              [ ] Elementary Student [ ] Out of school
Organizational Affiliation ________________________________ ________________
                                      Organization Name & Office Address             Position
Person to be notified in case of emergency __________________________,
                                                                NAME
   __________________________ , ____________________
             Address                    Contact No.

____________________________________________________________________________________
Climb Information
When do you intend to climb __________ ________ What trail/route you will use _______________
                                Start date       Return date
What is the purpose of your climb?
          [ ] Vacation/leisure        [ ] Mountaineering Activity           [ ] Research Studies
          [ ] Educational Visit       [ ] Monitoring Evaluation             [ ] Restoration/Rehabilitation
          [ ] Clean up drive          [ ] Tree planting                     [ ]Emergency Response
          [ ] Sports/Adventure        [ ] Others
What climbing/camping equipment do you have? [ ] tent             [ ] sleeping bag [ ]cooking stoves
                                                    [ ] Ropes [ ] Water container [ ] Flashlight
                                                    [ ] Others
Pls inventory your ratins and supplies that are hazardous to the environment:
                             No. of pcs.       Total weight       Descriptions
[ ] canned goods _________            __________         ________________
[ ] Bottled goods _________           __________         ________________
[ ] Bottled drinks _________          __________         ________________
[ ] Supplies in plastic      _________         __________         ________________
[ ] Cellophane bags          _________         __________         ________________
[ ] Others
_____________________________________________________________________
Climber’s Declaration (read carefully)
I hereby declares THAT all the information stated above are true and correct. THAT I will attend the pre-
climb orientation/briefing required by the LGU THAT I am physically fit and properly equipped to climb
Mt. Apo; THAT I will follow all applicable laws and regulations and policies; THAT I will protect and
preserve the environment and resources within Mt. Apo Natural Park; THAT I will bring down and dispose
my hazardous garbage at the designated area; THAT in case I suffer death or physical injury or incurred
whatever king of loss or dmage in the course of or relative to the climbing activities, I shall hold the LGU
or any of its employees completely free from any kind of liability and responsibility whatsoever; THAT I
have read and understood all the contents and statements provided in the application form.

_____________________________               _________________________           _____________________
 Printed Name of Climber                           Signature of Climber                Date Signed

FOR LGU use only

Climbing Fee _____________________
Proof of Payment ________________________________
                   OR No.      Date Issued
Climbing Permit No. ____________
Climber’s ID No. ______________
 Issued
Climb ing Permit No. ____________
Climber’s ID No. ______________

								
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