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HUPERNAKO FUTSAL ACADEMY

Bangorejo Rt 2 RW 10, Kwarasan, Grogol, Sukoharjo, Jawa Tengah – Indonesia


Telp. 0271-623352
cobfornations@gmail.com
www.yayasansaluranberkat.org

FORMULIR PENDAFTARAN

Yang bertanda tangan dibawah ini adalah pemohon, atau orang tua dari calon siswa :

NAMA : .............................................................................................................

TEMPAT, TGL LAHIR : .............................................................................................................

KELAHIRAN / USIA : .............................................. / ...........................................................

JENIS KELAMIN : .............................................................................................................

NO. TLPN / WA : .............................................................................................................

SEKOLAH : .......................................................... KELAS : .................................

NAMA ORANGTUA : .............................................................................................................

NO. TLPN ORTU / WA : .............................................................................................................

ALAMAT : .............................................................................................................

...............................................................................................................

HOBI : .............................................................................................................

MOTTO : .............................................................................................................

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(isi formulir selengkap-lengkapnya)

Solo, ........................................ 2019

Orang Tua / Wali Siswa

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