Advertisement
Not a member of Pastebin yet?
Sign Up,
it unlocks many cool features!
- <!DOCTYPE html>
- <html lang="en">
- <head>
- <meta charset="UTF-8">
- <meta name="viewport" content="width=device-width, initial-scale=1.0">
- <title>Formulir PPDB SMP Gemilang</title>
- </head>
- <body>
- <h2><img src="logo.png" alt="Logo" height="100px">FORMULIR PENDAFTARAN CALON SISWA BARU SMP</h2>
- <form action="#" method="post">
- <fieldset>
- <legend><strong>BIODATA SISWA</strong></legend>
- <div>
- <label for="">No. UN</label>
- <input type="text" name="noun" autofocus>
- </div>
- <div>
- <label for="">Nama Lengkap</label>
- <input type="text" name="nama" required>
- </div>
- <div>
- <label for="">Jenis Kelamin</label>
- <input type="radio" name="jk" value="Laki-laki">Laki-laki
- <input type="radio" name="jk" value="Perempuan">Perempuan
- </div>
- <div>
- <label for="">Tempat Lahir</label>
- <input type="text" name="tempat_lahir">
- </div>
- <div>
- <label for="">Tanggal Lahir</label>
- <input type="date" name="tanggal_lahir">
- </div>
- <div>
- <label for="">Nama Orangtua/Wali</label>
- <input type="text" name="ortu">
- </div>
- <div>
- <label for="">Alamat</label>
- <textarea name="alamat"></textarea>
- </div>
- <div>
- <label for="">Kota/Kabupaten</label>
- <input type="text" name="kota">
- </div>
- <div>
- <label for="">No. Telp/HP</label>
- <input type="text" name="hp">
- </div>
- <div>
- <label for="">Asal Sekolah</label>
- <input type="text" name="asal_sekolah">
- </div>
- <div>
- <label for="">Agama</label>
- <select name="agama">
- <option value="Islam">Islam</option>
- <option value="Kristen">Kisten</option>
- <option value="Protestan">Protestan</option>
- <option value="Hindu">Hindu</option>
- <option value="Budha">Budha</option>
- <option value="Konghucu">Konghucu</option>
- </select>
- </div>
- </fieldset>
- </form>
- </body>
- </html>
Advertisement
Add Comment
Please, Sign In to add comment
Advertisement