Nama Ibu/Bapa/Penjaga:__________________________________
Sila tandakan [ ] pada bidang yang diceburi.
Bidang
Sila Tanda
Peringkat
Anjuran/Kelab
1. Pengakap
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3. Pandu Puteri
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4. Kadet Remaja
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5. Renang
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7. Bola Sepak
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8. Bola Baling
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9. Bola Jaring
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10. Kriket
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11. Olahraga
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13. Tarian
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