Alamat :________________________________________________________
Ruj. Tuan:
Ruj. Kami:
Tarikh : ....................................
Nama
:............................................................................
Tarikh Aktiviti Ko-ku
:..............................................................
Persatuan/Permainan/Uniform:...............................................................................
Penjelasan:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Tandatangan pegawai,
...........................................
(Nama:
Disahkan oleh,
...............................................
PK Kokurikulum,
S.K Jenderam Hilir,
Sepang.