YAYASAN AL-AKMAL

KELOMPOK BERMAIN AL-AKMAL

TK MUHAIMAH
Alamat : J1 Warung Pulus No.02 Rt.02/14 Ds. Batujajar Barat
Kecamatan Batujajar Telepon (022) 6864581
FORMULIR PENDAFTARAN ANAK DIDIK BARU
TAHUN PELAJARAN :.
A. KETERANGAN ANAK DIDIK
1. Nama Lengkap
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2. Nama Panggilan
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3. Jenis Kelamin
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4. Tempat dan tanggal Lahir
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5. Agama
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6. Kewarganegaraan
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7. Anak Nomor Ke
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8. Jumlah Saudara Kandung
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9. Jumlah Saudara Tini
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10.Jumlah Saudara Angkat
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11.Bahasa Sehari-hari
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12.Berat Badan
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13.Tinggi Badan
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14.Golongan Darah
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15.Penyakit Berat yang Pernah Diderita...............................................................:
16.Alamat Tempat Tinggal
17.Bertempat Tinggal Pada
B. ORANGTUA / WALI
18.Nama
a. Ayah Kandung
b. Ibu Kandung
19.Pendidikan Tertinggi
a. Ayah Kandung
b. Ibu Kandung
20.Pekerjaan
a. Ayah Kandung
b. Ibu Kandung
21.Nama Wali Anak
22.Pendidikan tertinggi
23.Hubungan Terhadap Anak
C. ASAL MULA ANAK
24.Pekerjaan
25.Masuk TK ini Sebagai
26.Pindah Dari
a. Nama TK
b. Tanggal
27.Diterima Di TK ini
a. Tanggal
b. Di Kelompok
c. Diterima / Ditolak
d. Alasan

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Batujajar, .
Tanda Tangan Pendaftar

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