FORMULIR PENDAFTARAN ANGGOTA PRAMUKA

FORMULIR PENDAFTARAN ANGGOTA

GERAKAN PRAMUKA GUDEP TRI DARMA

SMP 4 BANGKALA BARAT

1.       Nama Lengkap                                  :...................................................................Pa/Pi

2.       Tempat dan Taggal Lahir               :...........................................................................

3.       Agama                                                  :...........................................................................

4.       Nama Orang Oua/Wali                  :...........................................................................

5.       Pekerjaan Orang Tua                      :...........................................................................

6.       Alamat Orang Tua                            :...........................................................................

7.       Anak ke                                                :......................... Jumlah Saudara.........................      

  Pa....................orang, Pi............................orang

8.       Golongan darah                               :...........................................................................

9.       Sekolah                                                                :...........................................................................

10.   Bakat dan Hobby                             :...........................................................................

11.   Hal-hal yang perlu diperhatikan

       ( Kebiasaan,Kesehatan,Bahasa yang di kuasai dan lain-lain )

                .............................................................................................................................

                .............................................................................................................................

                .............................................................................................................................

12.   Pengalaman dalam Kepramukaan:                           Tahun............Sebagai.................

                                                                                                 Tahun............Sebagai.................

                                                                                                 Tahun............Sebagai.................

13.   Lain-lain

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Beroanging, 01 September 2012

Pembina Pramuka

KAK HAMZAH,S.Pd