FORMULIR PENDAFTARAN

FORMULIR PENDAFTARAN
PESERTA POS PAUD MUTIARA KASIH
DESA GERINGGING JAYA
IDENTITAS ANAK :
1	Nama Lengkap	: .....................................................................................
2	Nama Panggilan	: .....................................................................................
3	Tempat/Tgl. Lahir	: .....................................................................................
4	No. & Tgl. Akta Lahir	: .....................................................................................
5	Anak Ke	: .....................................................................................
6	Berat Badan	: .....................................................................................
7	Tinggi Badan	: .....................................................................................
8	Alamat Rumah	: RT: .............. RW :............ Dusun : ..............................
		Desa ............................................................................
		Kecamatan ...................................................................
		No. HP. : .....................................................................
KONDISI ANAK :		: .....................................................................................
9	Berat Badan Saat Lahir	: .....................................................................................
10	Penyakit yang sering di derita	: .....................................................................................
11	Penyakit berat yg pernah diderita	:..................................................................................
12	Pantangan makanan	: .....................................................................................
		: .....................................................................................
IDENTITAS ORANG TUA :		: .....................................................................................
13	Nama Ayah Kandung	: .....................................................................................
14	Nama Ibu Kandung	: .....................................................................................
15	Pendidikan Terakhir Ayah	: .....................................................................................
16	Pendidikan Terakhir Ibu	: .....................................................................................
17	Pekerjaan Ayah	: .....................................................................................
18	Pekerjaan Ibu	: .....................................................................................
PERSYARATAN ADMINISTRASI :
19	Usia Anak minimal 3 tahun terhitung sejak Juli 2012.
20	Membayar Uang Administrasi Pendaftaran Rp.10.000,-
21	Membayar Iuran Siswa sebesar Rp.30.000,-/ bulan.
22	Menyerahkan Foto Copy Akte Kelahiran.
23	Menyerahkan Pas Photo ukuran 3 x 4 cm sebanyak 2 lembar (bisa menyusul)
			Geringging Jaya, ...................................
				Orang Tua/Wali,
				(..........................................)