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Formulir pendaftaran peserta didik sanggar seni

“ LINTANG PANDU SEKAR ”


Cabang Jeru IV, Tumpang, Malang.

1. Nama lengkap :.................................................................................................................


2. Jenis kelamin :.................................................................................................................
3. Tempat dan tanggal lahir :.................................................................................................................
4. Umur :.................................................................................................................
5. Menguasai tarian (a) :................................................................................................................
(b) :................................................................................................................
(c) :................................................................................................................
(d) :................................................................................................................
6. Alamat Rumah :.................................................................................................................
:.................................................................................................................
:.................................................................................................................
7. No telepon :.................................................................................................................
8. Status
a. Pelajar
b. Pekerja
9. Nama dan Alamat
Sekolahan/ Pekerjaan :.................................................................................................................
:.................................................................................................................
10. Nama orang tua
a. Ayah :.................................................................................................................
b. Ibu :.................................................................................................................
11. Alamat :.................................................................................................................
:.................................................................................................................

Malang,................ 2024

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Tanda Tangan Pendaftar

Sanggar Topeng Tumpang


“LINTANG PANDU SEKAR”
Jalan Mangun Dharma, Kemulan, Tulus Besar, Tumpang, Malang, 65156.
No.Hp/WA: 085791941684
E-mail: sanggar.lps@gmail.com Facebook: Sanggar Topeng Tumpang Lintangpandusekar.

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