Ceria Cemerlang

Jalan Jenderal sudirman (samping rutan baru) Larantuka

Phone number: 081345749658

Registration form

First name :.................................................................................................

Middle name : ................................................................................................
Last name : .................................................................................................
Gender : .................................................................................................
Place/Date of birthday : .................................................................................................
Address : ..................................................................................................
Email : ................................................................................................
Phone number : .................................................................................................
School name : .................................................................................................
Class : .................................................................................................
Learning Program :

Parent's name
Father name : ...................................................................................................
Mother name : ...................................................................................................

Parent's job
Father job : .................................................................................................
Mother job : .................................................................................................
Parent's phone number : ................................................................................................

Larantuka, ....................................

Parent's