FORMULIR PENDAFTARAN MURID BARU TAHUN PELAJARAN 20 /20

TK DHARMA WANITA PERSATUAN I KEJAYAN

Jl. Bambang Seketi No. 10 Kelurahan Kejayan Kec. Kejayan Kab. Pasuruan Kode Pos 67172

A. KETERANGAN TENTANG IDENTITAS ANAK

1. NIK / No. Akta : ........................................................................................................
2. Nama :
2.1 Nama Lengkap : ........................................................................................................
2.2 Nama Panggilan : ........................................................................................................
3. Jenis Kelamin : ........................................................................................................
4. Tempat/Tanggal Lahir : ........................................................................................................
5. Agama : ........................................................................................................
6. Alamat dan No. Telp : ........................................................................................................
........................................................................................................
7. Anak ke- : ........................................................................................................
8. Jumlah Saudara : ........................................................................................................
9. Status : ........................................................................................................
9.1 Yatim/Piatu/Yatim Piatu : ........................................................................................................
10. Bahasa sehari-hari di rumah : ........................................................................................................
11. Kewarganegaraan : ........................................................................................................
12. Kelainan Jasmani : ........................................................................................................

B. KETERANGAN IDENTITAS ORANG TUA / WALI

1. Ayah Kandung / Tiri / Angkat atau Wali
1.1 NIK : ........................................................................................................
1.2 Nama : .....................................................................................................
1.3 Tempat, Tanggal Lahir : ........................................................................................................
1.4 Agama : ........................................................................................................
1.5 Pendidikan tertinggi : ........................................................................................................
1.6 Pekerjaan : ........................................................................................................
1.7 Penghasilan : ........................................................................................................
1.8 Kewarganegaraan : ........................................................................................................
1.9 Alamat dan No. Telp : ........................................................................................................
2. Ibu Kandung / Tiri / Angkat atau Wali
2.1 NIK : ........................................................................................................
2.2 Nama : .....................................................................................................
2.3 Tempat, Tanggal Lahir : ........................................................................................................
2.4 Agama : ........................................................................................................
2.5 Pendidikan tertinggi : ........................................................................................................
2.6 Pekerjaan : ........................................................................................................
2.7 Penghasilan : ........................................................................................................
2.8 Kewarganegaraan : ........................................................................................................
2.9 Alamat dan No. Telp : ........................................................................................................
C. MUTASI
1. Diterima di TK ini : ........................................................................................................
2. Ditempatkan di : ........................................................................................................
3. Berasal dari : Keluarga / TK
4. Meninggalkan TK ini :
4.1 Karena : ........................................................................................................
4.1 Melanjutkan ke - : ........................................................................................................

D. KETERANGAN LAIN – LAIN TENTANG ANAK

1. Tinggal pada : orang tua / asrama/ menumpang
2. Jarak dari rumah ke TK : ........................................................................................................
3. Kesekolah dengan : jalan kaki / naik kendaraan
4. Bakat / Minat yang menonjol : ........................................................................................................
5. Golongan darah : ........................................................................................................

Kejayan,
Berat Badan Tinggi Badan Lingkar Kepala Orang Tua / Wali Murid

........................................
 FORMULIR PENDAFTARAN MURID BARU TAHUN PELAJARAN 20 /20
TK PGRI 2 KEJAYAN
Desa Ketangirejo Kecamatan Kejayan Kabupaten Pasuruan Kode Pos 67172

A. KETERANGAN TENTANG IDENTITAS ANAK

1. NIK / No. Akta : ........................................................................................................
2. Nama :
2.1 Nama Lengkap : ........................................................................................................
2.2 Nama Panggilan : ........................................................................................................
3. Jenis Kelamin : ........................................................................................................
4. Tempat/Tanggal Lahir : ........................................................................................................
5. Agama : ........................................................................................................
6. Alamat dan No. Telp : ........................................................................................................
........................................................................................................
7. Anak ke- : ........................................................................................................
8. Jumlah Saudara : ........................................................................................................
9. Status : ........................................................................................................
9.1 Yatim/Piatu/Yatim Piatu : ........................................................................................................
10. Bahasa sehari-hari di rumah : ........................................................................................................
11. Kewarganegaraan : ........................................................................................................
12. Kelainan Jasmani : ........................................................................................................

B. KETERANGAN IDENTITAS ORANG TUA / WALI

1. Ayah Kandung / Tiri / Angkat atau Wali
1.1 NIK : ........................................................................................................
1.2 Nama : .....................................................................................................
1.3 Tempat, Tanggal Lahir : ........................................................................................................
1.4 Agama : ........................................................................................................
1.5 Pendidikan tertinggi : ........................................................................................................
1.6 Pekerjaan : ........................................................................................................
1.7 Penghasilan : ........................................................................................................
1.8 Kewarganegaraan : ........................................................................................................
1.9 Alamat dan No. Telp : ........................................................................................................
2. Ibu Kandung / Tiri / Angkat atau Wali
2.1 NIK : ........................................................................................................
2.2 Nama : .....................................................................................................
2.3 Tempat, Tanggal Lahir : ........................................................................................................
2.4 Agama : ........................................................................................................
2.5 Pendidikan tertinggi : ........................................................................................................
2.6 Pekerjaan : ........................................................................................................
2.7 Penghasilan : ........................................................................................................
2.8 Kewarganegaraan : ........................................................................................................
2.9 Alamat dan No. Telp : ........................................................................................................
C. MUTASI
1. Diterima di TK ini : ........................................................................................................
2. Ditempatkan di : ........................................................................................................
3. Berasal dari : Keluarga / TK
4. Meninggalkan TK ini :
4.1 Karena : ........................................................................................................
4.1 Melanjutkan ke - : ........................................................................................................

D. KETERANGAN LAIN – LAIN TENTANG ANAK

1. Tinggal pada : orang tua / asrama/ menumpang
2. Jarak dari rumah ke TK : ........................................................................................................
3. Kesekolah dengan : jalan kaki / naik kendaraan
4. Bakat / Minat yang menonjol : ........................................................................................................
5. Golongan darah : ........................................................................................................

Ketangirejo,
Berat Badan Tinggi Badan Lingkar Kepala Orang Tua / Wali Murid

........................................
 FORMULIR PENDAFTARAN MURID BARU TAHUN PELAJARAN 20 /20
TK PGRI 3 KEJAYAN
Desa Cobanjoyo Kecamatan Kejayan Kabupaten Pasuruan Kode Pos 67172

A. KETERANGAN TENTANG IDENTITAS ANAK

1. NIK / No. Akta : ........................................................................................................
2. Nama :
2.1 Nama Lengkap : ........................................................................................................
2.2 Nama Panggilan : ........................................................................................................
3. Jenis Kelamin : ........................................................................................................
4. Tempat/Tanggal Lahir : ........................................................................................................
5. Agama : ........................................................................................................
6. Alamat dan No. Telp : ........................................................................................................
........................................................................................................
7. Anak ke- : ........................................................................................................
8. Jumlah Saudara : ........................................................................................................
9. Status : ........................................................................................................
9.1 Yatim/Piatu/Yatim Piatu : ........................................................................................................
10. Bahasa sehari-hari di rumah : ........................................................................................................
11. Kewarganegaraan : ........................................................................................................
12. Kelainan Jasmani : ........................................................................................................

B. KETERANGAN IDENTITAS ORANG TUA / WALI

1. Ayah Kandung / Tiri / Angkat atau Wali
1.1 NIK : ........................................................................................................
1.2 Nama : .....................................................................................................
1.3 Tempat, Tanggal Lahir : ........................................................................................................
1.4 Agama : ........................................................................................................
1.5 Pendidikan tertinggi : ........................................................................................................
1.6 Pekerjaan : ........................................................................................................
1.7 Penghasilan : ........................................................................................................
1.8 Kewarganegaraan : ........................................................................................................
1.9 Alamat dan No. Telp : ........................................................................................................
2. Ibu Kandung / Tiri / Angkat atau Wali
2.1 NIK : ........................................................................................................
2.2 Nama : .....................................................................................................
2.3 Tempat, Tanggal Lahir : ........................................................................................................
2.4 Agama : ........................................................................................................
2.5 Pendidikan tertinggi : ........................................................................................................
2.6 Pekerjaan : ........................................................................................................
2.7 Penghasilan : ........................................................................................................
2.8 Kewarganegaraan : ........................................................................................................
2.9 Alamat dan No. Telp : ........................................................................................................
C. MUTASI
1. Diterima di TK ini : ........................................................................................................
2. Ditempatkan di : ........................................................................................................
3. Berasal dari : Keluarga / TK
4. Meninggalkan TK ini :
4.1 Karena : ........................................................................................................
4.1 Melanjutkan ke - : ........................................................................................................

D. KETERANGAN LAIN – LAIN TENTANG ANAK

1. Tinggal pada : orang tua / asrama/ menumpang
2. Jarak dari rumah ke TK : ........................................................................................................
3. Kesekolah dengan : jalan kaki / naik kendaraan
4. Bakat / Minat yang menonjol : ........................................................................................................
5. Golongan darah : ........................................................................................................

Cobanjoyo,
Berat Badan Tinggi Badan Lingkar Kepala Orang Tua / Wali Murid

........................................
 FORMULIR PENDAFTARAN MURID BARU TAHUN PELAJARAN 20 /20
TAMAN KANAK-KANAK AS SHIDDIQIYYAH
Dusun Sumberwuni Desa Cobanjoyo Kec. Kejayan Kab. Pasuruan Kode Pos 67172

A. KETERANGAN TENTANG IDENTITAS ANAK

1. NIK / No. Akta : ........................................................................................................
2. Nama :
2.1 Nama Lengkap / No. Induk : ........................................................................................................
2.2 Nama Panggilan : ........................................................................................................
3. Jenis Kelamin : ........................................................................................................
4. Tempat/Tanggal Lahir : ........................................................................................................
5. Agama : ........................................................................................................
6. Alamat dan No. Telp : ........................................................................................................
........................................................................................................
7. Anak ke- : ........................................................................................................
8. Jumlah Saudara : ........................................................................................................
9. Status : ........................................................................................................
9.1 Yatim/Piatu/Yatim Piatu : ........................................................................................................
10. Bahasa sehari-hari di rumah : ........................................................................................................
11. Kewarganegaraan : ........................................................................................................
12. Kelainan Jasmani : ........................................................................................................

B. KETERANGAN IDENTITAS ORANG TUA / WALI

1. Ayah Kandung / Tiri / Angkat atau Wali
1.1 NIK : ........................................................................................................
1.2 Nama : .....................................................................................................
1.3 Tempat, Tanggal Lahir : ........................................................................................................
1.4 Agama : ........................................................................................................
1.5 Pendidikan tertinggi : ........................................................................................................
1.6 Pekerjaan : ........................................................................................................
1.7 Penghasilan : ........................................................................................................
1.8 Kewarganegaraan : ........................................................................................................
1.9 Alamat dan No. Telp : ........................................................................................................
2. Ibu Kandung / Tiri / Angkat atau Wali
2.1 NIK : ........................................................................................................
2.2 Nama : .....................................................................................................
2.3 Tempat, Tanggal Lahir : ........................................................................................................
2.4 Agama : ........................................................................................................
2.5 Pendidikan tertinggi : ........................................................................................................
2.6 Pekerjaan : ........................................................................................................
2.7 Penghasilan : ........................................................................................................
2.8 Kewarganegaraan : ........................................................................................................
2.9 Alamat dan No. Telp : ........................................................................................................
C. MUTASI
1. Diterima di TK ini : ........................................................................................................
2. Ditempatkan di : ........................................................................................................
3. Berasal dari : Keluarga / TK
4. Meninggalkan TK ini :
4.1 Karena : ........................................................................................................
4.1 Melanjutkan ke - : ........................................................................................................

D. KETERANGAN LAIN – LAIN TENTANG ANAK

1. Tinggal pada : orang tua / asrama/ menumpang
2. Jarak dari rumah ke TK : ........................................................................................................
3. Kesekolah dengan : jalan kaki / naik kendaraan
4. Bakat / Minat yang menonjol : ........................................................................................................
5. Golongan darah : ........................................................................................................

Cobanjoyo,
Berat Badan Tinggi Badan Lingkar Kepala Orang Tua / Wali Murid

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