Sample Blangko Pendaftaran

BLANGKO PENDAFTARAN
PONDOK PESANTREN HAMALATUL QUR’AN
Kembaran RT 04, Tamantirto, Kasihan, Bantul, Yogyakarta.
Telp. 0274372602
I. Identitas Diri
Nama : ­­­­­­­­­­­­­­­_______________________________________________
Jenis Kelamin : ­­­­­­­­­­­­­­­_______________________________________________
Tempat Tanggal Lahir: ­­­­­­­­­­­­­­­_______________________________________________
Umur : ­­­­­­­­­­­­­­­_______________________________________________
Nama Ayah : _______________________________________________
Nama Ibu : _______________________________________________
Nama Wali : _______________________________________________
Alamat/Asal : _______________________________________________
Asal Sekolah : _______________________________________________
Hobi : _______________________________________________
II. Identitas Orang Tua
1. Ayah
Nama Ayah : _______________________________________________
Umur : _______________________________________________
Agama : _______________________________________________
Pekerjaan : _______________________________________________
Alamat : _______________________________________________
2. Ibu
Nama Ibu : _______________________________________________
Umur : _______________________________________________
Agama : _______________________________________________
Pekerjaan : _______________________________________________
Alamat : _______________________________________________
III. Identitas Wali
Nama : _______________________________________________
Umur : _______________________________________________
Agama : _______________________________________________
Pekerjaan : _______________________________________________
Alamat : _______________________________________________

Bantul,
Calon Santri



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