FORMULIR PENDAFTARAN KHITAN MASSAL

I. Identitas orang Tua

a. Nama : .................................................................................................

b. Alamat : .................................................................................................

c. Pekerjaan : .................................................................................................

d. No Hp : .................................................................................................

II. Identitas Anak

a. Nama : .................................................................................................

b. Tempat Tanggal Lahir : .................................................................................................

c. Alamat : .................................................................................................

d. Sekolah : .................................................................................................

e. Umur : .................................................................................................

Ttd orang tua Pamekasan, 2021

(.................................) (Mohammad Fauzan S.Kom)

NB :

1. Formulir Harap diisi data yang lengkap

2. Setelah formulir diisi lengkap harap ditukar tiket dan pengambilan nomer urut ke panitia