Saya, ..................... pada tanggal .......................... menyatakan bahwa saya setuju melakukan
hal-hal dibawah ini:
1. ........................................................................................................................
2. ........................................................................................................................
3. ........................................................................................................................
Guru BK Konseli
....................................... .........................................
1. ........................................................................................................................
2. . ......................................................................................................................
3. ........................................................................................................................
Bila saya telah berhasil melakukan hal di atas, maka saya akan
mendapatkan: ...............................................................................................................................
..... .................................................................................................................................... ...........
.........................................................................................................................
Guru BK Konseli
..................................... ......................................