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BORANG PENDAFTARAN INDIVIDU
PERMAINAN/SUKAN :
SEKOLAH :
JANTINA : KUMPULAN UMUR :
R01
Nama Pemain :
Alamat Pemain : _____________________________________________________________________________________________
(Alamat Rumah)
_____________________________________________________________________________________________
No. Surat Beranak : Tarikh Lahir : __________________________________________
Kelas / Tahun : ___________________________________ Tarikh Daftar / Daftar Semula Ke Sekolah : __________________
No. Pendaftaran : ___________________________________ No. Angka Giliran UPSR : ____________________________________
Sediakan 2 keping
gambar ukuran
pasport,
1 keping lekatkan
di sini
AKUAN KEBENARAN IBUBAPA / PENJAGA
Nama IbuBapa / penjaga : No. KP : ___________________________________
No. Telefon (Pejabat) : No. Telefon bimbit : ____________________________________________________________
Saya bapa / penjaga kepada pelajar di atas mengesahkan segala keterangan di atas adalah benar dan gambar terbaru adalah betul. Saya juga
membenarkan anak / jagaan saya didaftarkan sebagai pemain _________________________ ____untuk pasukan _____________ dan
bersetuju mematuhi Perlembagaan, undang-undang, peraturan-peraturan, Pekeliling-pekeliling dan syarat-syarat mengenai pertandingan ini. Saya juga
faham bahawa pihak tuan sentiasa memberikan segala penerangan dan akan mengambil langkah-langkah keselamatan dan pengawasan yang diperlukan
sepanjang masa kejohanan tersebut.
Tandatangan : Tarikh : __________________________________
AKUAN GURU BESAR / GURU PENOLONG KANAN
Nama Guru Besar / Guru Penolong Kanan : No. Telefon Sekolah : _______________________
Alamat Sekolah :_____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
Saya mengesahkan segala keterangan di atas adalah betul dan gambar di atas adalah terbaru dan benar
_______________________________
( Tandatangan ) ( Nama Penuh & Cop Rasmi ) Tarikh
AKUAN PENGURUS PASUKAN DAN SETIAUSAHA AGUNG MSSM NEGERI / KETUA UNIT SUKAN JPN
Diakui penama di atas adalah ahli pasukan ini yang menyertai Kejohanan / Pertandingan Majlis Sukan Sekolah-Sekolah Malaysia
dan sepanjang pengetahuan saya semua maklumat yang diberi adalah benar.
Pengurus Pasukan Setiausaha Agung MSSM Negeri / Ketua Unit Sukan Negeri
Nama :
No. KP : Cop Rasmi
Jawatan :
Tarikh : Tarikh :

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04. r01

  • 1. BORANG PENDAFTARAN INDIVIDU PERMAINAN/SUKAN : SEKOLAH : JANTINA : KUMPULAN UMUR : R01 Nama Pemain : Alamat Pemain : _____________________________________________________________________________________________ (Alamat Rumah) _____________________________________________________________________________________________ No. Surat Beranak : Tarikh Lahir : __________________________________________ Kelas / Tahun : ___________________________________ Tarikh Daftar / Daftar Semula Ke Sekolah : __________________ No. Pendaftaran : ___________________________________ No. Angka Giliran UPSR : ____________________________________ Sediakan 2 keping gambar ukuran pasport, 1 keping lekatkan di sini AKUAN KEBENARAN IBUBAPA / PENJAGA Nama IbuBapa / penjaga : No. KP : ___________________________________ No. Telefon (Pejabat) : No. Telefon bimbit : ____________________________________________________________ Saya bapa / penjaga kepada pelajar di atas mengesahkan segala keterangan di atas adalah benar dan gambar terbaru adalah betul. Saya juga membenarkan anak / jagaan saya didaftarkan sebagai pemain _________________________ ____untuk pasukan _____________ dan bersetuju mematuhi Perlembagaan, undang-undang, peraturan-peraturan, Pekeliling-pekeliling dan syarat-syarat mengenai pertandingan ini. Saya juga faham bahawa pihak tuan sentiasa memberikan segala penerangan dan akan mengambil langkah-langkah keselamatan dan pengawasan yang diperlukan sepanjang masa kejohanan tersebut. Tandatangan : Tarikh : __________________________________ AKUAN GURU BESAR / GURU PENOLONG KANAN Nama Guru Besar / Guru Penolong Kanan : No. Telefon Sekolah : _______________________ Alamat Sekolah :_____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ Saya mengesahkan segala keterangan di atas adalah betul dan gambar di atas adalah terbaru dan benar _______________________________ ( Tandatangan ) ( Nama Penuh & Cop Rasmi ) Tarikh AKUAN PENGURUS PASUKAN DAN SETIAUSAHA AGUNG MSSM NEGERI / KETUA UNIT SUKAN JPN Diakui penama di atas adalah ahli pasukan ini yang menyertai Kejohanan / Pertandingan Majlis Sukan Sekolah-Sekolah Malaysia dan sepanjang pengetahuan saya semua maklumat yang diberi adalah benar. Pengurus Pasukan Setiausaha Agung MSSM Negeri / Ketua Unit Sukan Negeri Nama : No. KP : Cop Rasmi Jawatan : Tarikh : Tarikh :