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Formulir Pendaftaran
Penerimaan Santri Baru Al-Qur'an Center Ummu Habibah 2024/2025
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IDENTITAS CALON SANTRI
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Nama Lengkap Anak
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Nama Panggilan
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Tempat Lahir
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Tanggal Lahir
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Daftar Sebagai
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Santri baru (kelas 1)
Santri mutasi (pindahan)
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add "Other"
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Daftar ke kelas
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Kelas 1
Kelas 2
Kelas 3
Kelas 4
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Anak ke .....
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1
2
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Dari ..... bersaudara
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1
2
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RIWAYAT KESEHATAN
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Tinggi Badan
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dalam cm
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Berat Badan
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dalam kg
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Golongan Darah
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A
B
AB
O
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add "Other"
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Mata
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Normal
Berkacamata
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add "Other"
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Riwayat Penyakit
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tuliskan diagnosa, tahun, dan keterangan (di-opname atau tidak)
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Riwayat Imunisasi
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DPT, Polio, Hepatitis, BCG, meningitis, Campak, MMR, HIB, lain lain
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Kebiasaan Baik
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Kebiasaan Buruk
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KEPRIBADIAN
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Hobi
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Answer key
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Karakter yang Menonjol
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Potensi dan Bakat
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Prestasi yang Pernah Diraih
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Kebiasaan di Rumah
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Hiburan di Rumah
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TV
Komputer
Film Edukatif
Mainan Edukatif
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RIWAYAT PENDIDIKAN
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Sekolah Terakhir
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Playgroup
TK
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Nama Sekolah
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Alamat Sekolah
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DATA ORANG TUA
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Nama Lengkap Ayah
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Tanggal Lahir Ayah
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Pendidikan Terakhir Ayah
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SD
SMP
SMA
S1
S2
S3
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add "Other"
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Alamat Rumah Ayah
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No Telp Rumah Ayah
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No HP Ayah
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Pekerjaan Ayah
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Kemahiran Ayah
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Instansi Tempat Ayah Bekerja
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E-mail Ayah
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Nama Lengkap Ibu
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Tanggal Lahir Ibu
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Pendidikan Terakhir Ibu
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SD
SMP
SMA
S1
S2
S3
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add "Other"
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Alamat Rumah Ibu
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tulis "idem" bila sama dengan alamat rumah Ayah
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Answer key
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No Telp Rumah Ibu
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tulis "idem" bila sama dengan no telp rumah Ayah
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No HP Ibu
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Pekerjaan Ibu
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Instansi Tempat Ibu Bekerja
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tulis "rumah" bila Ibu adalah Ibu rumah tangga
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Kemahiran Ibu
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E-mail Ibu
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Informasi yang diketahui Tentang Al-Qur'an Center Ummu Habibah
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Alasan Ayah Memasukkan Santri ke Pesantren
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Alasan Ibu memasukkan Santri ke Pesantren
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Dari Mana Mendapatkan Informasi Penerimaan Santri Baru Al-Qur'an Center Ummu Habibah
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Website
Guru/pengurus Al-Qur'an Center Ummu Habibah
Wali Santri
Media Sosial
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IDENTITAS CALON SANTRI
Nama Lengkap Anak
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Nama Panggilan
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Tempat Lahir
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Tanggal Lahir
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Daftar Sebagai
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Daftar ke kelas
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Anak ke .....
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Dari ..... bersaudara
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RIWAYAT KESEHATAN
Tinggi Badan
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Berat Badan
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Golongan Darah
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Mata
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Riwayat Penyakit
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Riwayat Imunisasi
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Kebiasaan Baik
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Kebiasaan Buruk
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KEPRIBADIAN
Hobi
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Karakter yang Menonjol
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Potensi dan Bakat
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Prestasi yang Pernah Diraih
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Kebiasaan di Rumah
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Hiburan di Rumah
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RIWAYAT PENDIDIKAN
Sekolah Terakhir
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Nama Sekolah
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Alamat Sekolah
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DATA ORANG TUA
Nama Lengkap Ayah
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Tanggal Lahir Ayah
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Pendidikan Terakhir Ayah
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Alamat Rumah Ayah
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No Telp Rumah Ayah
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No HP Ayah
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Pekerjaan Ayah
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Kemahiran Ayah
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No responses yet for this question.
Instansi Tempat Ayah Bekerja
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E-mail Ayah
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Nama Lengkap Ibu
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Tanggal Lahir Ibu
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Pendidikan Terakhir Ibu
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Alamat Rumah Ibu
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No Telp Rumah Ibu
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No responses yet for this question.
No HP Ibu
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No responses yet for this question.
Pekerjaan Ibu
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No responses yet for this question.
Instansi Tempat Ibu Bekerja
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No responses yet for this question.
Kemahiran Ibu
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No responses yet for this question.
E-mail Ibu
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Informasi yang diketahui Tentang Al-Qur'an Center Ummu Habibah
Alasan Ayah Memasukkan Santri ke Pesantren
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Alasan Ibu memasukkan Santri ke Pesantren
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Dari Mana Mendapatkan Informasi Penerimaan Santri Baru Al-Qur'an Center Ummu Habibah
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