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FORMULIR PENDAFTARAN

FORMULIR PENDAFTARAN

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Dipublikasikan oleh Sylvia Zaidah

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Published by: Sylvia Zaidah on May 02, 2013
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05/25/2014

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FORMULIR PENDAFTARAN

PAUD BUMI GORA “TAMAN KANAK-KANAK”
TAHUN PELAJARAN _______________
A. BIODATA ANAK
1. Nama Lengka ! __________________________________________________________
". Nama Pangg#$an ! __________________________________________________________
%. Jen#& Ke$am#n ! __________________________________________________________
'. Tema() Tangga$ La*#+ ! __________________________________________________________
,. Anak ke- ! __________________________________________________________
-. T#ngg# Ba.an ! __________________________________________________________
/. Be+a( Ba.an ! __________________________________________________________
0. Ba*a&a 1e*a+#-*a+# ! __________________________________________________________
2. A$ama( ! __________________________________________________________
13.Ke$ak4an Anak .#+4ma* ! __________________________________________________________
11.Baka( ) M#na( 5ang men6n76$! __________________________________________________________
1".Un(4k men4n7ang en.#.#kan .an e+kem8angan 4(+a)4(+# an.a .#+4ma* (e+&e.#a!
Te$e9#&#
:;D $a5e+
Tae
+e<6+.e+
La#n - La#n ! ..............................................................
1%.Be+aa 8an5ak =ak(4 5ang an.a &e.#akan 4n(4k 4(+a ) 4(+# an.a
T#a *a+#
1e+#ng
Ka.ang-ka.ang ! ..............................................................
1'.>ak(4 +ek+ea&# 8e+&ama anak
1 ka$#
&e84$an
" ka$#
&e84$an
La#n-La#n ! ..............................................................
B. RIWAYAT KESEHATAN ANAK
1. 1ak#( 5ang e+na* .#.e+#(a ! _______________________________
". P4n5a a$e+g# (e+*a.a makanan) m#n4man ?7#ka 5a@ &e84(kanA !
_______________________________
C. BIODATA ORANG TUA
1. ABAH KANDUNG) TIRI) ANGKAT
a. Nama A5a* ! ____________________________________________
8. Tema(@ (angga$ La*#+ ! ____________________________________________
<. Agama ! ____________________________________________
.. Pen.#.#kan Te+ak*#+ ! ____________________________________________
e. Peke+7aan ) Ja8a(an ! ____________________________________________
C. Penge$4a+an e+ 84$an ! ____________________________________________
g. Peng*a&#$an e+ 84$an ! ____________________________________________
*. A$ama( R4ma*a ! ____________________________________________
#. N6. Te$e6n ! ____________________________________________
". IBU KANDUNG) TIRI) ANGKAT
a. Nama I84 ! ____________________________________________
8. Tema(@ (angga$ La*#+ ! ____________________________________________
<. Agama ! ____________________________________________
.. Pen.#.#kan Te+ak*#+ ! ____________________________________________
e. Peke+7aan ) Ja8a(an ! ____________________________________________
C. Penge$4a+an e+ 84$an ! ____________________________________________
g. Peng*a&#$an e+ 84$an ! ____________________________________________
*. A$ama( R4ma* ! ____________________________________________
#. N6. Te$e6n ! ____________________________________________
>a$# M4+#.

?____ _____________________________A

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