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FORMULIR PENDAFTARAN

A. KETERANGAN MURID
1. Nama Siswa : ............................................................................
2. NISN : ............................................................................
3. NIK : ............................................................................
4. Tempat Tanggal/ Lahir : ............................................................................
5. Agama : ............................................................................
6. Status Dalam Keluarga : ............................................................................
7. Anak Ke / Jumlah saudara : ....................................../.....................................
8. Bahasa sehari – hari : ............................................................................
9. Tinggi / Berat Badan : ...........................cm / ................................kg
10. Alamat Rumah : ...........................................................................
...........................................................................
11. Jarak dari rumah ke sekolah : ...........................................................................
12. Alat Transportasi yang Digunakan: .........................................................................

B. KETERANGAN ORANG TUA


1. Nama Orang Tua a. Ayah : ...........................................................................
b. Ibu : ...........................................................................
2. Pendidikan a. Ayah : ............................................................................
b. Ibu : ............................................................................
3. Pekerjaan a. Ayah : ............................................................................
b. Ibu : ............................................................................
4. Usia a. Ayah : ............................................................................
b. Ibu : ............................................................................
5. Alamat : ............................................................................
...........................................................................
...........................................................................
6. No HP/ Telepon : ...........................................................................
7. Penghasilan per Bulan : ...........................................................................
C. KETERANGAN WALI
1. Nama Wali : ..........................................................................
2. Pendidikan : ..........................................................................
3. Pekerjaan : ..........................................................................
4. Usia : ..........................................................................
5. Alamat : ........................................................................
............................................................................
6. No HP/ Telepon : ............................................................................

D. PERKEMBANGAN MURID
1. Asal Sekolah (SD/MI) : ..........................................................................
2. Di terima di sekolah ini tanggal : ..........................................................................

Pangandaran, 2020
Peserta Didik Orang Tua/ Wali

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