KELAB SENI DAN BUDAYA

LEKATKAN
SK MEDINI, 79100, ISKANDAR PUTERI, GAMBAR
JOHOR BAHRU, JOHOR BERUKURAN
PASPORT

MAKLUMAT AHLI : NO. AHLI : .........................

Nama Ahli : ................................................................................................................................

(Nama Penuh Seperti Dalam K.P)

No. Kad Pengenalan : ............................................................. Jantina : ...................................

Tarikh Lahir : .................................................. Tempat Lahir : ...................................................

Agama :........................................................... Bangsa : ...........................................................

Alamat : ......................................................................................................................................

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

MAKLUMAT IBU BAPA / PENJAGA :

Nama Bapa : ..............................................................................................................................

Pekerjaan : ...................................................... No. Kad Pengenalan : .....................................

No Telefon : (R) : ....................................................... (P) : ........................................................

(HP) : ......................................................

Nama Ibu : ..............................................................................................................................

Pekerjaan : ...................................................... No. Kad Pengenalan : .....................................

No Telefon : (R) : ....................................................... (P) : ........................................................

(HP) : ......................................................

Nama Penjaga : .........................................................................................................................

1
Pekerjaan : ...................................................... No. Kad Pengenalan : .....................................

No Telefon : (R) : ....................................................... (P) : ........................................................

(HP) : ......................................................

PERAKUAN AHLI :

Saya ..................................................................................................(Nama seperti dalam KP)

Tingkatan / Tahun ......................................................................................................................
berjanji akan menjadi ahli yang sentiasa mematuhi peraturan dan perlembagaan kelab,
peraturan sekolah dan sentiasa menjaga nama baik kelab dan sekolah di samping mencuba
sedaya upaya mengharumkan serta memartabatkan nama baik kelab dan sekolah ini.

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

(Tandatangan Ahli) (Tarikh)

( NAMA AHLI : )

Disediakan oleh,

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

(PUAN NUR MADIHAH BINTI HAMDAN) (Tarikh)

Ketua Guru Penasihat,

Kelab Seni dan Budaya

SK Medini, Johor Bahru