PENERIMAAN PESERTA DIDIK BARU ( PPDB )

TAHUN AJARAN 2020 – 2021

PENDIDIKAN ANAK USIA DINI ( PAUD )
IDENTITAS ANAK

1. Nama Lengkap : .............................................................................................................................................

2. Jenis Kelamin :.............................................................................................................................................
3. NIK :.............................................................................................................................................
4. Tempat/Tgl Lahir :.............................................................................................................................................
5. Agama :.............................................................................................................................................
6. Kewarganegaraan :.............................................................................................................................................
7. Alamat Lengkap :.............................................................................................................................................
:.............................................................................................................................................
8. Tinggal Bersama :.............................................................................................................................................
9. Anak Ke :.............................................................................................................................................
10. Usia :.............................................................................................................................................
11. Penyakit yang di derita :.................................................................................................................................
ORANG TUA

1. Nama Ayah :.............................................................................................................................................

NIK :.............................................................................................................................................
Tempat /Tgl. Lahir :................................................................................................................................
Pendidikan :.............................................................................................................................................
Pekerjaan :.............................................................................................................................................
HP :
2. Nama Ibu :.............................................................................................................................................
NIK :.............................................................................................................................................
Tempat /Tgl. Lahir :................................................................................................................................
Pendidikan :.............................................................................................................................................
Pekerjaan :.............................................................................................................................................
HP ::...........................................................................................................
PERIODIK

1. Tinggi Badan :.............................................................................................................................................

2. Berat Badan :.............................................................................................................................................
3. Jarak Tempuh :.............................................................................................................................................
4. Jumlah saudara :.............................................................................................................................................
REGISTER / DAFTAR ULANG

1. Jenis Pendaftaran / Daftar Ulang : A. Siswa Baru B. Pindahan c. Sekolah Lagi

2. Tgl masuk Sekolah :.............................................................................................................................................

3. No Induk Siswa :.............................................................................................................................................

4. Masuk Rombel : A / B (A . 4-5 tahunTua
Orang B. Siswa
5-6 tahun) Orang Tua Siswa

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