PERSAUDARAAN SETIA HATI TERATE CABANG BOGOR

RAYON PANDU
Sekretariat: Kampus Pandu, Jl. Raya Cibungbulang Km. Bogor 16630
e-mail: thinkbest1385@gmail.com; web: www.shteratepandu.co.cc;
(0251) 421550

FORMULIR PENDAFATARAN CALON SISWA

Saya yang bertandatangan di bawah ini:
Nama
:
..............................................................................................................................................
Tempat, Tanggal Lahir
:
..............................................................................................................................................
Agama
:
..............................................................................................................................................
Jenis kelamin
:
..............................................................................................................................................
Tinggi/berat badan
:
........................ cm / ....................... kg
Golongan darah
:
..............................................................................................................................................
Alamat
:
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
Sekolah
:
..............................................................................................................................................
Kelas/Tingkat
:
..............................................................................................................................................
Nama orang tua
:
Ayah : ..................................................................................................................................
Ibu : ..................................................................................................................................
Siap mengikuti peraturan-peraturan yang ada di Persaudaraan Setia Hati Terate Rayon Pandu, Cabang Bogor.
Cibungbulang, ......................................20...
Calon siswa,

(.........................................................)

PERSAUDARAAN SETIA HATI TERATE CABANG BOGOR

RAYON PANDU
Sekretariat: Kampus Pandu, Jl. Raya Cibungbulang Km. Bogor 16630
e-mail: thinkbest1385@gmail.com; web: www.shteratepandu.co.cc ;
(0251) 421550

FORMULIR PENDAFATARAN CALON SISWA

Saya yang bertandatangan di bawah ini:
Nama
:
..............................................................................................................................................
Tempat, Tanggal Lahir
:
..............................................................................................................................................
Agama
:
..............................................................................................................................................
Jenis kelamin
:
..............................................................................................................................................
Tinggi/berat badan
:
........................ cm / ....................... kg
Golongan darah
:
..............................................................................................................................................
Alamat
:
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
Sekolah
:
..............................................................................................................................................
Kelas/Tingkat
:
..............................................................................................................................................
Nama orang tua
:
Ayah : ..................................................................................................................................
Ibu : ..................................................................................................................................
Siap mengikuti peraturan-peraturan yang ada di Persaudaraan Setia Hati Terate Rayon Pandu, Cabang Bogor.
Cibungbulang, ......................................20...
Calon siswa,

(.........................................................)