FORMAT :
M – 1
FORMULIR PENDAFTARAN
Tahun Pelajaran 20... – 20...
NAMA SEKOLAH : TK
TUNAS 1
NOMOR STATISTIK SEKOLAH :
002021401022
STATUS SEKOLAH :
SWASTA
ALAMAT SEKOLAH : JL.
DESA MEKARJAYA
DESA / KELURAHAN *) :
MEKARJAYA
KECAMATAN :
BAREGBEG
KABUPATEN / KOTA *) :
CIAMIS
PROVINSI :
JAWA BARAT
KETERANGAN
ANAK
1.
Nama Lengkap :
.............................................................................................................
2.
Nama Panggilan : .............................................................................................................
3.
Jenis Kelamin : .............................................................................................................
4.
Tanggal dan Tempat Lahir :
.............................................................................................................
5.
Agama : .............................................................................................................
6.
Kewarganegaraan :
.............................................................................................................
7.
Anak Ke :
.............................................................................................................
8.
Banyaknya Saudara Kandung :
.............................................................................................................
9.
Banyaknya Saudara Tiri :
.............................................................................................................
10.
Banyaknya Saudara Angkat :
.............................................................................................................
11.
Bahasa Sehari-hari :
.............................................................................................................
12.
Berat Badan :
.............................................................................................................
13.
Tinggi Badan :
.............................................................................................................
14.
Golongan Darah :
.............................................................................................................
15.
Penyakit yang pernah diderita :
.............................................................................................................
16.
Alamat, No Telp. Tempat Tinggal :
.............................................................................................................
17.
Bertempat Tinggal Pada : .............................................................................................................
ORANG TUA /
WALI
18. Nama Ayah Kandung/Ibu Kandung : ..................................................../....................................................
19. Pend. Tertinggi Ayah Kandung/Ibu : .........................................................................................................
20. Pekerjaan/Jabatan/Swasta/Wirast. *) :
Peg. Negeri Sispil/TNI/POLISI/Swasta/Petani/Buruh/Nelayan
21. Nama Wali Siswa :
.........................................................................................................
22. Pendidikan Tertinggi Wali :
.........................................................................................................
23. Hubungan Wali Terhadap Anak : .........................................................................................................
24.
Pekerjaan / Jabatan Wali *) : Peg. Negeri
Sispil/TNI/POLISI/Swasta/Petani/Buruh/Nelayan
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Kepala TK TUNAS 1
TUTI HERMIATI, S.Pd
NIP. 19660830 198803 2 004
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Orang Tua / Wali *)
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