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..........................................................................: