RAYON PANDU

Sekretariat: Kampus Pandu, Jl. Raya Cibungbulang Km. Bogor 16630

e-mail: thinkbest1385@gmail.com; web: www.shteratepandu.co.cc; (0251) 421550

FORMULIR PENDAFATARAN CALON SISWA

Saya yang bertandatangan di bawah ini:

Nama : ..............................................................................................................................................
Tempat, Tanggal Lahir : ..............................................................................................................................................
Agama : ..............................................................................................................................................
Jenis kelamin : ..............................................................................................................................................
Tinggi/berat badan : ........................ cm / ....................... kg
Golongan darah : ..............................................................................................................................................
Alamat : ..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
Sekolah : ..............................................................................................................................................
Kelas/Tingkat : ..............................................................................................................................................
Nama orang tua : Ayah : ..................................................................................................................................
Ibu : ..................................................................................................................................
Siap mengikuti peraturan-peraturan yang ada di Persaudaraan Setia Hati Terate Rayon Pandu, Cabang Bogor.

Cibungbulang, ......................................20...
Calon siswa,

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

PERSAUDARAAN SETIA HATI TERATE CABANG BOGOR

RAYON PANDU
Sekretariat: Kampus Pandu, Jl. Raya Cibungbulang Km. Bogor 16630
e-mail: thinkbest1385@gmail.com; web: www.shteratepandu.co.cc ; (0251) 421550

FORMULIR PENDAFATARAN CALON SISWA

Saya yang bertandatangan di bawah ini:

Nama : ..............................................................................................................................................
Tempat, Tanggal Lahir : ..............................................................................................................................................
Agama : ..............................................................................................................................................
Jenis kelamin : ..............................................................................................................................................
Tinggi/berat badan : ........................ cm / ....................... kg
Golongan darah : ..............................................................................................................................................
Alamat : ..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
Sekolah : ..............................................................................................................................................
Kelas/Tingkat : ..............................................................................................................................................
Nama orang tua : Ayah : ..................................................................................................................................
Ibu : ..................................................................................................................................
Siap mengikuti peraturan-peraturan yang ada di Persaudaraan Setia Hati Terate Rayon Pandu, Cabang Bogor.

Cibungbulang, ......................................20...
Calon siswa,

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