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BIODATA PESERTA ATLETIK

( DISETOR KE JURI/SEKSI PERLOMBAAN )

CABANG PERLOMBAAN : ................................................................................

NAMA : ................................................................................

TEMPAT TANGGAL LAHIR : ................................................................................

NISN : ................................................................................

KELAS : ................................................................................

ASAL SEKOLAH / GUGUS : SDN ……………………….. / GUGUS …………

KEPALA SEKOLAH : ................................................................................

NIP : ................................................................................

Mulya Jaya, 21 Februari 2024

Guru Pedamping

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