Formulir
Formulir
Formulir penerimaan tamu ambalan SMA Negeri 1 Mamuju tahun ajaran 2018/2019
1. Nama lengkap :...........................................................................................
Nama panggilan :...........................................................................................
2. Jenis kelamin :...........................................................................................
3. Tempat, tanggal lahir :...........................................................................................
4. Kelas :...........................................................................................
5. Asal sekolah :...........................................................................................
6. Berat/Tinggi Badan :...........................................................................................
7. No Telpon :...........................................................................................
8. Alamat :...........................................................................................
9. Agama :...........................................................................................
10.Penyakit yang pernah di derita:...............................................................................................
11.Orang tua/Wali :
Ayah :............................................................................................
Ibu :............................................................................................
12. No Telpon orang tua :............................................................................................
13.Pengalaman pramuka :.............................................................................................
.............................................................................................
14.Alasan masuk :............................................................................................
.............................................................................................
Pas Foto
3 cm X 4 cm Mamuju,...............................
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