DATA ATLET
| 1. | Nama Lengkap | : | ................................................................................................... |
| 2. | Tempat/Tanggal Lahir | : | ................................................................................................... |
| 3. | Jenis Kelamin | : | ................................................................................................... |
| 4. | Asal Sekolah | : | ................................................................................................... |
| 5. | Alamat Sekolah | : | ................................................................................................... |
| 6. | Tingkat di Perisai Diri | : | ................................................................................................... |
| 7. | Nomor yang diikuti | : | ................................................................................................... |
| ................................................................................................... | |||
| 8. | Berat Badan | : | ..................................... Kg. |
| 9. | Tinggi Badan | : | ..................................... Cm |
| 10. | Penyakit yang pernah | : | ................................................................................................... |
| diderita | ................................................................................................... |
|
Bandung, .................................. 2002
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