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FORMULIR PENDAFTARAN DAN PERIZINAN ORANG TUA


CALON ANGGOTA BARISAN EKSEKUTIF SISWA
SMK NEGERI 1 ADIWERNA

1. Nama Lengkap : ...................................................................................


2. Tempat Tanggal Lahir : ...................................................................................
3. Alamat : ...................................................................................
4. Nomor Telefon : ...................................................................................
5. Facebook/Whatsapp : ...................................................................................
6. Prestasi yang dimiliki : 1. ...............................................................................
2. ..............................................................................
3. ...............................................................................
7. Pengalaman Berorganisasi : ...................................................................................
8. Perizinan Orang tua : Diizinkan/Tidak diizinkan

..................., ..... September 2019

Pendaftar Orang Tua Pendaftar

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

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