<html>
<head>
<title>© REGISTRASI SISWA</title>
</head>
<body>
<form name="billing" method="post" action="proses.php">
<fieldset>
<legend> <b>INPUT DATA REGISTRASI SISWA dan ORANG TUA</b> </legend>
<table width="100%" border="0" cellspacing="0" cellpadding="5">
<tr>
<td width="10%">Tahun Ajaran</td>
<td width="1%">:</td>
<td width="24%"><input name="ajar" type="text" maxlength=""></td>
<td width="12%">Nama Ayah</td>
<td width="1%">:</td>
<td width="24%"><input name="ayah" type="text"></td>
</tr>
<tr>
<td width="10%">NIS</td>
<td width="1%">:</td>
<td width="24%"><input name="nis" type="text"></td>
<td width="12%">Nama Ibu</td>
<td width="1%">:</td>
<td width="24%"><input name="ibu" type="text"></td>
</td>
</tr>
<tr>
<td width="10%">Nama Siswa</td>
<td width="1%">:</td>
<td width="24%"><input name="siswa" type="text"></td>
<td width="12%">Pekerjaan Ayah</td>
<td width="1%">:</td>
<td width="24%"><input name="p_ayah" type="text"></td>
</td>
</tr>
<tr>
<td width="10%">Diterima di Kelas</td>
<td width="1%">:</td>
<td width="24%"><input name="kelas" type="text"></td>
<td width="12%">Pekerjaan Ibu</td>
<td width="1%">:</td>
<td width="24%"><input name="p_ibu" type="text"></td>
</td>
</tr>
<tr>
<td width="10%">Tempat lahir</td>
<td width="1%">:</td>
<td width="24%"><input name="Lahir" type="text"></td>
<td width="12%"> </td>
<td width="1%"> </td>
<td width="24%"> </td>
</tr>
<tr>
<td width="10%">Tanggal Lahir</td>
<td width="1%">:</td>
<td width="24%">Tgl-
<select name="tgl" size="1">
<option>01</option>
<option>02</option>
<option>03</option>
<option>04</option>
<option>05</option>
<option>06</option>
<option>07</option>
<option>08</option>
<option>09</option>
<option>10</option>
<option>11</option>
<option>12</option>
<option>13</option>
<option>14</option>
<option>15</option>
<option>16</option>
<option>17</option>
<option>18</option>
<option>19</option>
<option>20</option>
<option>21</option>
<option>22</option>
<option>23</option>
<option>24</option>
<option>25</option>
<option>26</option>
<option>27</option>
<option>28</option>
<option>29</option>
<option>30</option>
<option>31</option>
</select>
Bln-
<select name="bulan">
<option>01</option>
<option>02</option>
<option>03</option>
<option>04</option>
<option>05</option>
<option>06</option>
<option>07</option>
<option>08</option>
<option>09</option>
<option>10</option>
<option>11</option>
<option>12</option>
</select>
Thn-
<input name="thn" type="text" size="4">
</td>
<td width="12%">Alamat Orang Tua</td>
<td width="1%">:</td>
<td width="24%%"><textarea name="a_ortu" cols="26" rows="2"></textarea></td>
</tr>
<tr>
<td width="10%%">Jenis Kelamin</td>
<td width="1%">:</td>
<td width="24%%"><input name="radio" type="radio" value="Pria">
Pria <br>
<input name="radio" type="radio" value="wanita">
Wanita </td>
<td width="12%"> </td>
<td width="1%"> </td>
<td width="24%%"> </td>
</tr>
<tr>
<td width="10%">Agama</td>
<td width="1%">:</td>
<td width="24%">
<select name="agama" size="1">
<option>Islam</option>
<option>Kristen</option>
<option>Katolik</option>
<option>Hindu</option>
<option>Budha</option>
</select></td>
<td width="12%">Penghasilan Orang Tua</td>
<td width="1%">:</td>
<td width="24%%"><input name="hasil" type="text"></td>
</tr>
<tr>
<td width="10">Alamat Siswa</td>
<td width="1">:</td>
<td width="20%"><textarea name="a_siswa" cols="26" rows="2"></textarea></td>
<td><input name="proses" type="submit" id="Ok" value=" Ok "><input name="hapus" type="reset" id="Cancel" value=" Cancel "></td>
<td> </td>
<td> </td>
</tr>
</table>
</fieldset>
</form>
</body>
</html>
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