Borang Pendaftaran

_____________________________________________________________________________________ PASUKAN PENGAKAP KELANA “B” (PAHLAWAN) PERSEKUTUAN PENGAKAP MALAYSIA ZON PUDU 8 Jalan Makmur,Bandar Tun Razak, Chras 56000 Kuala Lumpur TEL: 03-91710215 HP: 012-3631411

BORANG PENDAFTARAN PROGRAM ”HUNT & FUN” Lengkapkan semua bahagian. Borang ini boleh difotokopi. Nama Penuh: ...................................................................................................................................... (Huruf Besar) No. Kad Pengenalan: .......... ............................................................................................................... Alamat Rumah: .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... No. Telefon: (R)............................................................ (H/P)............................................................... Umur: ……................................…..............

Jantina: ..............................................................

Keturunan: ............................................. ...

Agama: .............................................................

No. Kumpulan: ...........................................

Daerah: .............................................................

Sekiranya terdapat kecemasan, siapa perlu kami hubungi. Nama:............................................................................... Hubungan: ................................................... No. Telefon: (R)............................................................ (H/P)............................................................... Alamat Rumah: .................................................................................................................................... .................................................................................................................................... ....................................................................................................................................

Adakah anda mengidap sebarang jenis penyakit, kecacatan, alahan atau apa-apa jenis masalah kesihatan? Jika ya, sila nyatakan dibawah. ............................................................................................................................................................... ............................................................................................................................................................... . Saya faham bahawa pihak penganjur Program “Hunt & Fun” telah mengambil kira segala bentuk langkah keselamatan yang perlu dan saya juga tidak akan mengambil sebarang bentuk tindakan kepada pihak penganjur Program “Hunt & Fun” jikalau berlaku kehilangan harta benda, kecederaan atau kehilangan nyawa terhadap anak / jagaan saya semasa dan setelah menyertai program ini.

.................................................. Tandatangan Ibubapa / Penjaga

.................................................. Tandatangan Peserta

.................................................. Tt. & Cop Pemimpin Kumpulan