PENERIMAAN PESERTA DIDIK BARU (PPDB)

PENDIDIKAN ANAK USIA DINI ( PAUD )

KELOMPOK BERMAIN (KB) AL-WAFA
MUKTISARI GANDRUNGMANGU
TAHUN AJARAN 2021/2022
Alamat : Jl. Apel kuning RT 04/01, Desa Muktisari Kec. Gandrungmangu
Email : paudalwafamuktisari@gmail.com C I L A C A P Kode Pos 53254
IDENTITAS

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

2. Jenis kelamin : .................................................................................................
3. NIK : .................................................................................................
4. Tempat tgl Lahir : .................................................................................................
5. Agama : .................................................................................................
6. Kewarganegaraan : .................................................................................................
7. Alamat Lengkap : .................................................................................................
: .................................................................................................
8. Tinggal bersama : .................................................................................................
9. Anak ke : .................................................................................................
10. Usia : .................................................................................................
11. NO HP : .................................................................................................

ORANGTUA

1. Nama ayah : .................................................................................................

NIK : .................................................................................................
Tahun lahir : .................................................................................................
Pendidikan : .................................................................................................
Pekerjaan : .................................................................................................
2. Nama Ibu : .................................................................................................
NIK : .................................................................................................
Tahun lahir : .................................................................................................
Pendidikan : .................................................................................................
Pekerjaan : .................................................................................................

PERIODIK

1. Tinggi Badan : .................................................................................................

2. Berat Badan : .................................................................................................
3. Jarak Tempuh : .................................................................................................
4. Jumlah Saudara : .................................................................................................

REGISTER

1. Jenis Pendaftaran : A. Siswa baru B. Pindahan C. Sekolah lagi

2. Tgl masuk sekolah : .................................................................................................
3. No Induk Siswa : .................................................................................................
4. Masuk Rombel : A/B ( A.3-4 B.5-6 )

Ttd Guru Ttd

Orang Tua Siswa

................................... ...................................
 SIAP MASUK SEKOLAH

0821-3885-5673

0852-9030-0670

paudalwafamuktisari@gmail.com