FORMULIR PENDAFTARAN MURID BARU

SD NEGERI 8 KEMBIRITAN TAHUN AJARAN 2022 / 2023

IDENTITAS DIRI SISWA BARU

1. Nama Lengkap : ..................................................................................................
2. Jenis Kelamin : ..................................................................................................
3. Tempat & Tanggal Lahir : ..................................................................................................
4. Agama : ..................................................................................................
5. Anak Ke : ................................. dari ........................................... Saudara
6. Status : Anak Kandung / Anak tiri / Anak Angkat (anak kandung*)
7. Alamat Siswa : ..................................................................................................
..................................................................................................
No. Telepon................................................................................
8. Diterima di Sekolah Ini :
a. Di kelas : ..................................................................................................
b. Pada Tanggal : ..................................................................................................
9. Sekolah Asal :
a. Nama Sekolah : ..................................................................................................
b. Alamat : ..................................................................................................
10. Nama Orang Tua :
a. Ayah : …...............................................................................................
b. Ibu : ..................................................................................................
11. Pendidikan Orang Tua :
a. Ayah : ..................................................................................................
b. Ibu : ..................................................................................................
12. Alamat Orang Tua : ..................................................................................................
.....................................................................................................

No. Telepon................................................................................

13. Pekerjaan Orang Tua :

a. Ayah : ..................................................................................................
b. Ibu : ..................................................................................................
14. Nama Wali : ..................................................................................................
15. Pekerjaan wali : ..................................................................................................
16. Alamat Wali : ..................................................................................................
....................................................................................................
No. Telepon.................................................................................

(*) Coret yang tidak perlu

Banyuwangi, ........................ 2022
NB : Mohon di lampiri: Wali Murid / Pendaftar
1. Ijazah TK (jika ada)
a. FC Kartu Keluarga
2. FC Akte Kelahiran