Pendaftaran Santri Baru - Pesantren Al-Ma'had Bekasi
(Kolom bertanda Bintang * Wajib di isi)
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DATA CALON SANTRI
Nama Lengkap Calon Santri (Sesuai Akte Kelahiran) *
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Jenis Kelamin *
Tempat Lahir *
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Tanggal Lahir *
MM
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DD
/
YYYY
Status Mendaftar di Kelas *
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Pilihan Tingkatan Kelas *
Status dalam Keluarga *
Anak Ke *
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Jumlah Saudara Kandung *
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Berat Badan (kg)
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Tinggi Badan (cm)
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Golongan Darah
Riwayat Penyakit
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