Scheda di iscrizione

Scheda di iscrizione (click col destro e poi Salva oggetto)

 

SCHEDA DI  ISCRIZIONE 

 

Dati  riguardanti il bambino         

COGNOME                                                                         NOME                                                                                               

Sesso:                      Maschio [  ]              Femmina  [  ]

DATA DI NASCITA                                              LUOGO DI NASCITA                                                                                     

PROVINCIA                                                       

RESIDENTE IN VIA                                                                                       LOCALITA’                                                      

CAP                                      

TELEFONO ABITAZIONE                                                                   

REPERIBILITA’ URGENTE                                                                                                                                                       

EVENTUALI ALLERGIE ED ALTRE SEGNALAZIONI                                                                                                             

                                                                                                                                                                                                         

DOCUMENTAZIONE  SANITARIA PRESENTATA  [   ]

ISCRIZIONE NELLE LISTE DEGLI ASILI NIDI COMUNALI                   SI   [  ]                NO  [  ]

RICHIESTA DEL SERVIZIO                DALLE ORE                        ALLE ORE                      

RETTA   €                            

COSTO ISCRIZIONE  €                                                   

PADRE :                COGNOME                                         NOME                                                  Data di nascita                   

                                PROFESSIONE                                                                                                 

MADRE :                COGNOME                                         NOME                                                  Data di nascita                   

                                PROFESSIONE                                                                                                                                               

ALTRI COMPONENTI                                                                                                                                                             

                                                                                                                                                                                                         

PAGAMENTO  ISCRIZIONE   SI [  ]    NO [  ]             

               

PAGAMENTO RETTA PRIMO MESE DI FREQUENZA     SI [  ]   NO [  ]

Data     /       /     /                                                                        Firma    per accettazione