Formulir Vaksinasi

KUISIONER VAKSINASI SISWA
SMA NEGERI 1 RANDANGAN

NIS

Silakan Masukan NIS anda.. Untuk Mengecek NIS anda Silakan Klik https://smarandangan.blogspot.com/2016/02/blog-post.html

NAMA LENGKAP SISWA SESUAI IJAZAH

KELAS

XII IPA 1

XII IPA 2

XII IPA 3

XII IPS 1

XII IPS 2

XII IPS 3

XI IPA 1

XI IPA 2

XI IPA 3

XI IPS 1

XI IPS 2

XI IPS 3

X IPA 1

X IPA 2

X IPA 3

X IPS 1

X IPS 2

X IPS 3

1. Apakah Anda Siap di Vaksin

Ya

Tidak

2. Jika Jawaban Anda "TIDAK", Apa Alasanmu? Jika "YA", di isi dengan Angka Nol (0)

3. Apakah Ayah Anda Mengizinkan Anda di Vaksin? Jika Tidak Apa Alasannya?

Masukan No. HP yang Aktif!

JS // This script requires jQuery and jquery-form plugin // You can use these ones from Cloudflare CDN: // // // $('#bootstrapForm').submit(function (event) { event.preventDefault() var extraData = {} $('#bootstrapForm').ajaxSubmit({ data: extraData, dataType: 'jsonp', // This won't really work. It's just to use a GET instead of a POST to allow cookies from different domain. error: function () { // Submit of form should be successful but JSONP callback will fail because Google Forms // does not support it, so this is handled as a failure. alert('Form Submitted. Thanks.') // You can also redirect the user to a custom thank-you page: // window.location = 'http://www.mydomain.com/thankyoupage.html' } }) })

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