FORMULIR PENDAFTARAN SISWA BARU

KB MUTIARA BUNDA DESA TIDU TAHUN PELAJARAN 2020/2021

1.A. IDENTITAS ANAK
1. Nama Lengkap :................................................................................................
2. Nama Panggilan :................................................................................................
3. Tempat & Tanggal Lahir :......................................................................................
4. Jenis Kelamin :.....................................................................................
5. Usia :............................tahun............................bulan
6. Alamat Rumah :....................................................................................
......................................................................................
7. Agama :....................................................................................
8. Kewarganegaraan :.....................................................................................
9. Anak ke :......................................................................................
10. Jumlah Saudara Kandung :.......................................................................................
B. IDENTITAS ORANG TUA
1.1. Ayah
1. Nama :.....................................................................................
2. Tempat & Tanggal Lahir :......................................................................................
3. Agama :.....................................................................................
4. Pendidikan :....................................................................................
5. Pekerjaan :....................................................................................
6. Alamat Rumah :....................................................................................
......................................................................................
7. No. HP :....................................................................................

2.2 IBU
1. Nama :.....................................................................................
2. Tempat & Tanggal Lahir :......................................................................................
3. Agama :.....................................................................................
4. Pendidikan :....................................................................................
5. Pekerjaan :....................................................................................
6. Alamat Rumah :....................................................................................
......................................................................................
7. No. HP :....................................................................................

Pasuruan,........................................
Hormat saya

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