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FORMULIR PENDAFTARAN SISWA (I) BARU TAHUN AJARAN 2013 - 2014

No

No Induk

Nama Siswa (i)

: .......................................................................................................

Nama Ayah

: .......................................................................................................

Nama Ibu

: .......................................................................................................

Tempat, tanggal lahir

: ......................................................................................................

Jenis Kelamin

: O Laki- laki

Anak Ke

: ........... ( ............... )

Status dalam keluarga

: O Sulung

Kelas mulai masuk

: ........... ( ............... )

Berasal dari sekolah

: ......................................................................................................

Alamat murid

: ......................................................................................................

Alamat orang tua / Wali

: ......................................................................................................

Pekerjaan orang tua / Wali

: ......................................................................................................

Biaya pendaftaran

: Rp 50.000 ,-

O Perempuan

O Bungsu

O Lunas

O Tengah

O Tunggal

O Belum lunas

Biaya pendaftaran sudah termasuk SPP 2 bulan ( Juli Agustus 2013 ) dan infaq bulan Ramadhan
1434 H

Cempaka, ....... Juni 2013


Orang tua murid / Wali

Petugas
Penerima Siswa (i) Baru

( ....................................... )

( .................................... )

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