Nama : ..................................................................................................................
Tempat, tanggal lahir : ...................................................................................................................
Alamat : ...................................................................................................................
: ...................................................................................................................
No telp : ...................................................................................................................
NIS : ...................................................................................................................
Nama : ...................................................................................................................
Kelas : ...................................................................................................................
Alamat : ...................................................................................................................
: ...................................................................................................................
No telp : ..................................................................................................................
Menyatakan tidak keberatan /mengizinkan anak saya untuk mengikuti Praktik Kerja Lapangan
(PKL) sesuai penempatan dari sekolah.
Demikian surat persetujuan ini saya buat dengan sebenar-benarnya tanpa ada paksaan dari pihak
manapun.
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Orang Tua/Wali
(...........................................................)