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  • Formulir Pendaftaran Paud

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    jayabina
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    FORMULIR PENDAFTARAN PAUD

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    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
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    22K views1 page

    Formulir Pendaftaran Paud

    Uploaded by

    jayabina

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    FORMULIR PENDAFTARAN

    Tahun Pelajaran : ..
    No. Urut :..
    A. Keterangan Murid
    1. Nama Murid (Nama Panggilan)
    2. Jenis Kelamin
    3. Kelahiran
    4.
    5.
    6.
    7.
    8.
    9.

    : ..................................................................................
    : Laki-laki / Perempuan
    : a. Tempat : ...............................................................
    b. Tanggal/bln/thn :..................................................
    Agama
    : ..................................................................................
    Suku Bangsa
    : ..................................................................................
    Anak Ke
    : ..................................................................................
    Jumlah Saudara kandung / tiri/ angkat : ../
    /
    /
    Alamat dan No Telepon
    : ..................................................................................
    ....................................................................................
    Bertempat Tinggal Pada
    : Orang tua/ Nenek/ Saudara/ ...................................

    B. Keterangan Orang Tua / Wali Murid


    1. Nama ORang Tua Kandun
    2. Tempat Tanggal Lahir
    3. Pendidikan Terakhir
    4. Pekerjaan
    5. Agama
    6. Alamat / No. Tlp

    :a. Ayah
    b. Ibu
    :a. Ayah
    b. Ibu
    :a. Ayah
    b. Ibu
    :a. Ayah
    b. Ibu
    :a. Ayah
    b. Ibu
    :a. Ayah
    b. Ibu

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

    C. Keadaan Murid pada Umumnya


    1. Berat Badan / Tinggi Badan
    : .. Kg / Cm
    2. Penyakit yang Pernah Diderita
    :
    3. Kecelakaan yang Pernah Dialami :
    4. Kelainan Khusus dalam Berperilaku : ..
    D. 1. Diterima Tanggal
    2. Keluar Tanggal

    : ..
    : ........... Alasan :..

    Ketua,

    Depok, ..........................201....
    Orang Tua Murid

    ....................

    ........................................

    *) Coret yang tidak perlu

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