YAYASAN DARUL ASYFA DINASTY

Jalan Totokan Mijil No. 01 Dusun Ponggok, Desa Ponggok, Kec

Ponggok, Kab. Blitar Jawa Timur
Phone : 085 704 411 460, Email : darulasfa@gmail.com

FORMULIR PENDAFTARAN
KELAS TAHSIN AL QUR’AN (IKHWAN)
No:
I. DATA PESERTA
1. Nama Lengkap : ....................................................................................................................
2. Tempat dan Tanggal Lahir : ....................................................................................................................
3. Alamat : Jl. …………………………… Rt …………. Rw ………... No. ………..
Kel. …………………………. Kec. …………………………………………..
4. Pendidikan Terakhir : a. SD b. MTs/SMP c.MA/SMA d. Diploma e. S1/S2
5. Pengalaman Belajar
: a. .............................................................
Al Qur’an
b. .............................................................
c. .............................................................
6. Pekerjaan : a. Karyawan b. PNS c. Ibu RT d. Lain – lain........................
7. Status Pernikahan : ....................................................................................................................

II. DATA INFORMASI DIRI

1. Nomer Telp / WA : ....................................................................................................................
2. E-mail : ....................................................................................................................
3. Nomer Telp / WA keluarga
: ....................................................................................................................
yang bisa di hubungi
4. Sosial Media : a. Facebook b. Instagram c. Lain - lain
………………… ………………… .........................

III. PERNYATAAN DIRI

1. Apa alasan Anda bergabung dengan Kelas Tahsin Al Qur’an ?
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2. Kemampuan Membaca Al Qur'an anda saat ini :
a. Belum bisa b. Sudah Bisa c. Sudah Mahir
3. Apakah Anda bersedia mengikuti pembelajaran penuh sampai selesai ?
......................................................................................................................................................................
......................................................................................................................................................................
4. Apakah Anda bersedia mematuhi segala peraturan dan kebijakan yang berlaku di kelas Tahsin
Al Qur’an Darul ASYFA ?
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5. Apa harapan Anda setelah bergabung dengan Kelas Tahsin Al Qur’an Darul ASYFA ?
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Ponggok,..... Agustus 2019

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