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YAYASAN AL-IKHWAN NAGARAJAYA

PENDIDIKAN ANAK USIA DINI (PAUD)


LIGAR MUNGGARAN
DESA NAGARAJAYA KEC. PANAWANGAN KAB. CIAMIS
AKTA NOTARIS: JULISTIAWATI, SH. NO. 01 TGL 05 OKTOBER 2015
Dusun Emblegan RT.007 RW.002 Desa Nagarajaya Kec. Panawangan 46255 Tlp. 085352365957

BIODATA
CALON PESERTA DIDIK PAUD LIGAR MUNGGARAN

A. Kelompok Bermain (Kober) usia 2-4 tahun


B. Taman Kanak-kanak (TK) usia 4-6 tahun

1. Nama : ................................................................................................
2. Nomor Induk : ................................................................................................
3. Temat/ tanggal lahir : ................................................................................................
4. Jenis Kelamin : ................................................................................................
5. Agama : ................................................................................................
6. Alamat : Dusun ............................................. RT. ....... RW. .................
Desa .................................... Kecamatan ...............................
7. Mulai Masuk PAUD ini : ................................................................................................
8. Nama Orang Tua
a. Ayah : ................................................................................................
Tanggal Lahir : ................................................................................................
Pendidikan Terakhir : ................................................................................................
b. Ibu : ................................................................................................
Tanggal Lahir : ................................................................................................
Pendidikan Terakhir : ................................................................................................
9. Alamat Orang Tua : ................................................................................................
10. Pekerjaan Orang Tua : ................................................................................................
11. Wali : ................................................................................................
a. Nama : ................................................................................................
b. Alamat : ................................................................................................
c. Pekerjaan : ................................................................................................

Nagarajaya, .............................. 20....


Yang Mendaftarkan

.............................................
Catatan :
Wajib melampirkan :
1. foto kopi akta kelahiran 1 lembar bagi yang sudah memiliki
2. Foto copy kartu keluarga (KK)
3. Foto Copy KTP orang Tua

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