PAUD DAR UMMI FATIMAH

Keterangan tentang diri siswa

1. Nama calon siswa : .......................................................................................................................

2. Jenis kelamin : {Laki-Laki * /Perempuan* }
3. Tempat tanggal lahir : .......................................................................................................................
4. Jumlah saudara : ...................................................... Anak ke : ................................................
5. Alamat siswa : .......................................................................................................................

Data orang tua siswa

1. Nama orang tua

a) ayah : .......................................................................................................................
b) ibu : .......................................................................................................................
2. Alamat orang tua
a) ayah : .......................................................................................................................
b) ibu : .......................................................................................................................
3. Pekerjaan orang tua
a) ayah : .......................................................................................................................
b) ibu : .......................................................................................................................
4. Pendidikan orang tua
a) ayah : .......................................................................................................................
b) ibu : .......................................................................................................................
5. No hp orang tua
a) ayah : .......................................................................................................................
b) ibu : .......................................................................................................................
Biaya Pendaftaran : Rp. 500.000(sudah termasuk perlengkapan buku, SPP, dan seragam)
Perkengkapan buku(iqro’, dll) : Rp. 100.000;
SPP bulan Juni : Rp.100.000;
Seragam (batik dan olahraga) : Rp.200.000;

Palembang, ................20.....
 Wali
murid