Hari / Tanggal : ................................................................ Hari / Tanggal : ................................................................
Nama : ................................................................ Nama : ................................................................ Kelas : ................................................................ Kelas : ................................................................ Alasan Keluar : ................................................................ Alasan Keluar : ................................................................ ................................................................. ................................................................. Jam Keluar : ................................................................ Jam Keluar : ................................................................ Jam Kembali : ................................................................ Jam Kembali : ................................................................ Limboto, Limboto, Mengetahui Mengetahui Guru Pembimbing Guru MP/Wali Kelas Guru Pembimbing Guru MP/Wali Kelas
Hari / Tanggal : ................................................................ Hari / Tanggal : ................................................................
Nama : ................................................................ Nama : ................................................................ Kelas : ................................................................ Kelas : ................................................................ Alasan Keluar : ................................................................ Alasan Keluar : ................................................................ ................................................................. ................................................................. Jam Keluar : ................................................................ Jam Keluar : ................................................................ Jam Kembali : ................................................................ Jam Kembali : ................................................................ Limboto, Limboto, Mengetahui Mengetahui Guru Pembimbing Guru MP/Wali Kelas Guru Pembimbing Guru MP/Wali Kelas
Hari / Tanggal : ................................................................ Hari / Tanggal : ................................................................
Nama : ................................................................ Nama : ................................................................ Kelas : ................................................................ Kelas : ................................................................ Alasan Keluar : ................................................................ Alasan Keluar : ................................................................ ................................................................. ................................................................. Jam Keluar : ................................................................ Jam Keluar : ................................................................ Jam Kembali : ................................................................ Jam Kembali : ................................................................ Limboto, Limboto, Mengetahui Mengetahui Guru Pembimbing Guru MP/Wali Kelas Guru Pembimbing Guru MP/Wali Kelas