FORMULIR PENDAFTARAN SISWA BARU

SPS PAUD “MAWAR MELATI”

TAHUN PELAJARAN 2021_2022

Sekretariat: Jln. Jalan Raya No. 01 Karangrejo kode pos 61154

No. Induk Siswa :

I. Data Siswa
1. Nama : ..................................................................................
2. Nama Panggilan : ..................................................................................
3. Tempat, tanggal Lahir : ..................................................................................
4. Jenis Kelamin : ..................................................................................
5. Agama : ..................................................................................
6. Berat badan & tinggi badan : ..................................................................................
7. Alamat : ..................................................................................

II. Data Orang Tua / Wali murid

Identitas Ayah
1. Nama Ayah : ..................................................................................
2. Tempat, tanggalLahir : ..................................................................................
3. Pendidikan : ..................................................................................
4. Pekerjaan : ..................................................................................
5. Alamat : ..................................................................................

Identitas Ibu
1. Nama Ibu : ..................................................................................
2. Tempat, tanggalLahir : ..................................................................................
3. Pendidikan : ..................................................................................
4. Pekerjaan : ..................................................................................
5. Alamat : ..................................................................................
6. No. Telepon : ............................................................

III. Keterangan Administrasi : * foto kopi KK & akte kelahiran 1 lembar

 Foto 3x4 (2 lembar)
 Foto kopi KTP Ayah & Ibu

Karangrejo, 30 Mei 2021

Kepala Taman Posyandu PAUD “MAWAR MELATI”

LAILATUL KHOTIMAH,S.Pd.I

* FORMULIR paling lambat di kumpulkan pada tgl