FORMULIR REGISTRASI

VAMOS ACADEMY MAKASSAR

Nama Depan : _____________________________________________

Nama Belakang : _____________________________________________

Berat Badan : _____________________________________________

Tinggi Badan : _____________________________________________

Tempat/Tanggal Lahir : _____________________________________________

Alamat : _____________________________________________

_____________________________________________

_____________________________________________

Sekolah : _____________________________________________

Agama : _____________________________________________

Nama Orang Tua / Wali : _____________________________________________

Telp. Orang Tua / Wali : _____________________________________________

Riwayat Penyakit : _____________________________________________

_____________________________________________

…….…………. , …………………………………

Mengetahui,

Peserta Orang Tua / Wali

PAS FOTO

3X4

(…………………….................) (………………..…………………….)