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Formulir Pendaftaran Peserta PAUD

Formulir Pendaftaran Peserta PAUD

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Published by Risa Ariani

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Published by: Risa Ariani on Nov 19, 2013
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08/26/2014

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Formulir Pendaftaran Peserta PAUD

Identitas anak :
1. Nama Lengkap : ____________________________
2. Nama Panggilan :_____________________________
3. Tempat dan Tanggal Lahir :_____________________________
4. Nomor dan Akta Lahir :_____________________________
5. Anak Ke :_____________________________
. !erat !adan :_____________________________
". Tinggi !adan :_____________________________
#. Alamat $%mah :_____________________________
____________________________
Kondisi Anak
&. !erat !adan Anak saat lahir :_____________________________
1'. Pen(akit (ang sering diderita :_____________________________)*
11. Pen(akit (ang pernah diderita :___________________tah%n ++..)*
12. Pantangan ,akan : ____________________________)*
Identitas orangt%a
13. Nama a(ah kand%ng :_____________________________
14. Nama I-% Kand%ng :_____________________________
15. Pendidikan terakhir a(ah :_____________________________
1. Pendidikan terakhir i-% :_____________________________
1". Peker.aan A(ah :_____________________________
1#. Peker.aan I-% :_____________________________
Loa K%l%/ ____________________
0rangt%a12ali/
3____________________*
Keterangan :
Data dalam formulir pendaftaran ini dimasukkan kedalam Buku Induk Anak dan Formulir
isian ini diarsipkan selama 5 tahun.
*) Bila ada

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