NAMA
DARJAH
TAHUN
1. Nama
2. Tarikh Lahir :
3. Alamat :
4. Darjah/Tahun :
5. Nama Sekolah :
6. No.Telefon Sekolah :
7. Nama Guru Pengakap/Pemimpin
(a)
(b)
8. Nama Bapa :
9. Nama Ibu :
10 Nombor Telefon :
KERIS PERAK
LULUS
GAGAL
Tandatangan Penguji :
Tarikh :
Bil
Perkara
Tandatangan
.
1
Lagu Negaraku
2
3
4
5
6
Lagu negeri
Persetiaan Pengakap
Undang-Undang Pengakap
Peti Pertolongan Cemas
Asas Perbarisan
Hormat dan Salam
7
8
9
Penguji
Pengakap
Simpulan Buku Sila
KESETIAAN
1.
Lagu Negaraku
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2. Lagu Negeri
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Lukiskan:
a.
2.
Mengetahui RUKUNEGARA
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1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Agama Buddha-Tokong
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KESIHATAN
DAN
KESELAMATAN
16
1.
2.
Kebersihan
a. Gigi b. Kuku c. Rambut
d. Tangan dan kaki
Keracunan ...........................................................
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3.
Memakai kasut.
a. ................................................................................
b.
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4.
................................................................................
Bahaya ubat
a. ................................................................................
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5.
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Bahaya Penyakit Berjangkit.
a. ................................................................................
b. ................................................................................
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6.
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Bahaya Benda Tajam.
a. ................................................................................
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b.
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7.
8.
9.
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Cara Mendapat Bantuan.
a. ................................................................................
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b. Telefon :
a.
b.
c.
d.
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KECEKAPAN
1.
Asas Perbarisan.
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2.
3.
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4.
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5.
Tempat-tempat awam
:
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6.
25
26
7.
27
8.
Bunga geti
Simpul manuk
Buku sila
Tindih kasih
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PENYERTAAN
30
Pilih 2 sahaja.
1.
2.
a. ..................................................................................
b. ................................................................................
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3.
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4.
5.
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a.
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:
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b.
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c.
:
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PERKHIDMATAN
32
1.
Tugasan
Membasuh pinggan
Menyapu sampah
Menjaga adik
Mengemas rumah
2.
3.
peraturan sekolah.
Menyediakan buku log perkhidmatan sendiri
menandakan perkhidmatan sukarelanya.
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4.
5.
ibadat.
Melakukan satu lakonan perkhidmatan
masyarakat yang telah diberikan.
Tanda tangan :
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Nama : ..........................................................
Tarikh : .....................................................
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