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FORMULIR PENDAFTARAN

SELEKSI DEWAN PENGGALANG


GUGUS DEPAN 17.0561-17.0562
SMP NEGERI 1 WANGON

Nama lengkap :.....................................................................................................


Tempat tanggal lahir :.....................................................................................................
Jenis kelamin :.....................................................................................................
Agama :.....................................................................................................
Nama orang tua/wali :.....................................................................................................
Pekerjaan orang tua/wali :.....................................................................................................
Alamat rumah :.....................................................................................................
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No. Handphone :………………………………………………………………….
Anak ke :.......................................... Jumlah Saudara :.....................
Golongan darah :.....................................................................................................
Bakat/hobi :.....................................................................................................
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Riwayat penyakit :.....................................................................................................
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Tinggi badan :........................................... Berat badan :.....................
Pengalaman Kepramukaan :.....................................................................................................
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Mengetahui, Wangon,....,…………..2022
Orangtua / Wali Pendaftar

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