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B-PSA
- BRITISH COLUMBIA
APPLICATION FOR ADULT MEMBERSHIP [
] NEW
[ ] RETURNING Mr/Mrs____________________________________________________________________________________________
Family Name
Given Names Address__________________________________
__________________________________________________ City___________________________________
Province_______________
Postal Code____________________ Date
of Birth___/___/___/(D/M/Y/)
Place of Birth:_______________________
Citizenship? ________________ Home
Phone:_______________
Business Phone:_________________
Email:___________________________ Occupation_________________________________
Employer_______________________________________ Adult
Service in Scouting/Guiding:
APPLICANTS
AGREEMENT: I subscribe to, and
will actively pursue, the principles that I must, to the best of my ability,
love and serve my God, respect the responsibilities and rights of individuals,
and act in accordance with human dignity. I undertake to be
guided by the policies of BPSA - BC and to do my best to further the aim of the
movement. I release The BPSA -
British Columbia and its Leaders, Directors and Officers of any responsibility
or liability for any injury or damage to person or property whatsoever sustained
in connection with its activities. I have submitted my
Police Record Check to the Group. Applicants
Signature_______________________________
Date______________ Group
_____________________________ The annual fee of $30
is enclosed:
[ ] Cash
[ ] Cheque
(Cheques made payable to: “BPSA - BC Provincial Council") On behalf of the
Group/Council, I have reviewed the interview and references as recorded on the
reverse of this form. I recommend
the acceptance for membership of the named applicant as: (write in the
appropriate position)
_____________________________________________ Signed on behalf of the
Group/Council:___________________________________________________________ AS
A PRECAUTIONARY MEASURE ALL VOLUNTEER APPLICANTS MUST PROVIDE THE BPSA - BC WITH
FOUR CHARACTER REFERENCES THESE
REFERENCES MUST HAVE PERSONALLY KNOWN YOU FOR A MINIMUM OF TWO YEARS. NO
FAMILY MEMBERS ARE PERMITTED. PLEASE
COMPLETE THE FOLLOWING :
PLEASE
REMEMBER, YOU WILL BE RESPONSIBLE WITH
OTHER PEOPLE’S CHILDREN. THEIR
SAFETY AND WELL-BEING
MUST COME FIRST. |
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Last modified: October 15, 2016.