FORMULIR PENDAFTARAN SISWA BARU (2)
FORMULIR PENDAFTARAN SISWA BARU
A.
KETERANGAN
1.
Nama Lengkap
:
......................................................................
2.
Nama Panggilan
:
......................................................................
3.
Jenis Kelamin
:
Laki-laki / Perempuan
4.
Tempat dan Tanggal lahir
:
......................................................................
5.
Agama
:
......................................................................
6.
Kewarganegaraan
:
WNI / WNA Keturunan
7.................................................................................................................................Anak ke:(dari
...................................................................................................................................
saru ibu)
8.................................................................................................................................Jumlah
saudara
kandung.....................................................................................................................:
...................................................................................................................................orang
9.................................................................................................................................Jumlah
saudara
tiri...............................................................................................................................:
...................................................................................................................................orang
10.
.............................................................................................................................Jumlah saudara
angkat........................................................................................................................:
...................................................................................................................................orang
11...............................................................................................................................Bahasa
seharihari.............................................................................................................................:
...................................................................................................................................Indonesia /
Jawa / Madura
12...............................................................................................................................Berat badan
...................................................................................................................................:
...................................................................................................................................kg
13...............................................................................................................................Tinggi badan
...................................................................................................................................:
...................................................................................................................................cm
14.
Golongan darah
:
......................................................................
15.
Penyakit yang pernah diderita
:
......................................................................
16.
Alamat tempat tinggal, no telepon
:
......................................................................
17.
Bertempat tinggal pada
:
Orang Tua / Saudara / Menupang
- Ayah kandung
:
......................................................................
- Ibu kandung
:
......................................................................
- Ayah
:
......................................................................
- Ibu
:
......................................................................
Pekerjaan orang tua
:
PNS / TNI / POLRI / Peg. Swasta / Pensiunan /
B.
18.
19.
20.
ORANG TUA / WALI
Nama orang tua
Pendidikan tertinggi orang tua
Wieaswasta / Petani / Pedagang / Nelayan *
- Ayah
:
......................................................................
- Ibu
:
......................................................................
21.
Nama wali siswa
:
......................................................................
22.
Pendidikan tertinggi
:
......................................................................
23.
Hubungan terhadap anak
:
......................................................................
24
Pekerjaan wali
:
PNS / TNI / POLRI / Peg. Swasta / Pensiunan /
Wieaswasta / Petani / Pedagang / Nelayan *
C.
ASAL MULA ANAK
25.
kelas
Masuk sekolah ini sebagai............................................................:
Siswa
26.
tangga
Asal
anak .....................................................................................a.
:
Rumah
:
b.........................................................................................Nama TK
c. Nomor/th. Surat Ket.......................................................:
:
27.
d.........................................................................................Lama
...........................................................................................
tahunbelajar
Diterima disekolah ini
a. .......................................................................................Tanggal :
b. Di Kelas..........................................................................:
A.
KETERANGAN
1.
Nama Lengkap
:
......................................................................
2.
Nama Panggilan
:
......................................................................
3.
Jenis Kelamin
:
Laki-laki / Perempuan
4.
Tempat dan Tanggal lahir
:
......................................................................
5.
Agama
:
......................................................................
6.
Kewarganegaraan
:
WNI / WNA Keturunan
7.................................................................................................................................Anak ke:(dari
...................................................................................................................................
saru ibu)
8.................................................................................................................................Jumlah
saudara
kandung.....................................................................................................................:
...................................................................................................................................orang
9.................................................................................................................................Jumlah
saudara
tiri...............................................................................................................................:
...................................................................................................................................orang
10.
.............................................................................................................................Jumlah saudara
angkat........................................................................................................................:
...................................................................................................................................orang
11...............................................................................................................................Bahasa
seharihari.............................................................................................................................:
...................................................................................................................................Indonesia /
Jawa / Madura
12...............................................................................................................................Berat badan
...................................................................................................................................:
...................................................................................................................................kg
13...............................................................................................................................Tinggi badan
...................................................................................................................................:
...................................................................................................................................cm
14.
Golongan darah
:
......................................................................
15.
Penyakit yang pernah diderita
:
......................................................................
16.
Alamat tempat tinggal, no telepon
:
......................................................................
17.
Bertempat tinggal pada
:
Orang Tua / Saudara / Menupang
- Ayah kandung
:
......................................................................
- Ibu kandung
:
......................................................................
- Ayah
:
......................................................................
- Ibu
:
......................................................................
Pekerjaan orang tua
:
PNS / TNI / POLRI / Peg. Swasta / Pensiunan /
B.
18.
19.
20.
ORANG TUA / WALI
Nama orang tua
Pendidikan tertinggi orang tua
Wieaswasta / Petani / Pedagang / Nelayan *
- Ayah
:
......................................................................
- Ibu
:
......................................................................
21.
Nama wali siswa
:
......................................................................
22.
Pendidikan tertinggi
:
......................................................................
23.
Hubungan terhadap anak
:
......................................................................
24
Pekerjaan wali
:
PNS / TNI / POLRI / Peg. Swasta / Pensiunan /
Wieaswasta / Petani / Pedagang / Nelayan *
C.
ASAL MULA ANAK
25.
kelas
Masuk sekolah ini sebagai............................................................:
Siswa
26.
tangga
Asal
anak .....................................................................................a.
:
Rumah
:
b.........................................................................................Nama TK
c. Nomor/th. Surat Ket.......................................................:
:
27.
d.........................................................................................Lama
...........................................................................................
tahunbelajar
Diterima disekolah ini
a. .......................................................................................Tanggal :
b. Di Kelas..........................................................................: