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SEKOLAH KEBANGSAANDATUKHJ.BAGINDA
UMBAI 77300 MERLIMAUMELAKA
TEL: 06-2610317/FAKS: 06-2610360
PENGAKUANKEBENARAN IBUBAPA / PENJAGA
TAJUK PROGRAM / AKTIVITI : LATIHAN MUZIK CAKLEMPONG KELAB SENI BUDAYA/ PANITIA MUZIK
TARIKH / MASA : SETIAP HARI SABTU (MENGIKUTJADUAL)
TEMPAT : BILIK MUZIK SKDHB
1. Saya _______________________________________ (No.K.P) ______________________________________
(nama ibu/bapa(HURUFBESAR) (No. Ic ibu/bapa/penjaga)
MEMBENARKAN / TIDAK MEMEBENARAKAN anak/Pelajardi bawahjagaansayabernama
(potong yang tidak berkenaan) (potongyang tidakberkenaan)
_______________________________________________________ No.Surat Beranak ___________________________________
(nama anak(HURUF BESAR) (No. SB. Anak)
Tahun ________________ dari SK DATUK HAJIBAGINDA menyertai aktiviti tersebut.
2. Saya sedarbahawapihakpenganjurakanmengambil tindakansertalangkahkeselamatanyangperludan
wajarbagi memastikankeselamatananak/jagaansayasemasamenjalani programini.
3. Saya akan menasihati danmengingatkananak/jagaansayasupayapatuhkepadaarahanyang diberikanoleh
guru semasaprogramdijalankan.
4. Saya jugamemberi kebenarankepadapihakpenganjurprogramatauwakil memberi apa-aparawatanatau
pertolonganperubatankepadaanak/jagaansayajikadidapati perluolehpihakberkenaan.
Sekian,terimakasih.
Tandatanganibubapa/penjaga ________________________________________________________________
NomborKadPengenalan ________________________________________________________________
AlamatRumah ________________________________________________________________
________________________________________________________________
________________________________________________________________
NomborTelefonRumah@Bimbit ________________________________________________________________
Tarikh ________________________________________________________________
PengesahanGuruBesar& cop ________________________________________________________________
Catatan : Borang ini hendaklahdibawabersama-samasemasapendaftarandandiserahkankepada URUSETIA.
Satu salinanuntuksimpanansekolah.

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  • 1. SEKOLAH KEBANGSAANDATUKHJ.BAGINDA UMBAI 77300 MERLIMAUMELAKA TEL: 06-2610317/FAKS: 06-2610360 PENGAKUANKEBENARAN IBUBAPA / PENJAGA TAJUK PROGRAM / AKTIVITI : LATIHAN MUZIK CAKLEMPONG KELAB SENI BUDAYA/ PANITIA MUZIK TARIKH / MASA : SETIAP HARI SABTU (MENGIKUTJADUAL) TEMPAT : BILIK MUZIK SKDHB 1. Saya _______________________________________ (No.K.P) ______________________________________ (nama ibu/bapa(HURUFBESAR) (No. Ic ibu/bapa/penjaga) MEMBENARKAN / TIDAK MEMEBENARAKAN anak/Pelajardi bawahjagaansayabernama (potong yang tidak berkenaan) (potongyang tidakberkenaan) _______________________________________________________ No.Surat Beranak ___________________________________ (nama anak(HURUF BESAR) (No. SB. Anak) Tahun ________________ dari SK DATUK HAJIBAGINDA menyertai aktiviti tersebut. 2. Saya sedarbahawapihakpenganjurakanmengambil tindakansertalangkahkeselamatanyangperludan wajarbagi memastikankeselamatananak/jagaansayasemasamenjalani programini. 3. Saya akan menasihati danmengingatkananak/jagaansayasupayapatuhkepadaarahanyang diberikanoleh guru semasaprogramdijalankan. 4. Saya jugamemberi kebenarankepadapihakpenganjurprogramatauwakil memberi apa-aparawatanatau pertolonganperubatankepadaanak/jagaansayajikadidapati perluolehpihakberkenaan. Sekian,terimakasih. Tandatanganibubapa/penjaga ________________________________________________________________ NomborKadPengenalan ________________________________________________________________ AlamatRumah ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ NomborTelefonRumah@Bimbit ________________________________________________________________ Tarikh ________________________________________________________________ PengesahanGuruBesar& cop ________________________________________________________________ Catatan : Borang ini hendaklahdibawabersama-samasemasapendaftarandandiserahkankepada URUSETIA. Satu salinanuntuksimpanansekolah.