Giochi  Sportivi Studenteschi 2002 - 2003

 

MODELLO  B

 

POSIZIONE DEI PARTECIPANTI

 

SCUOLA / ISTITUTO ___________________________________ DI _____________________

 

DATA DELL’EVENTO __________________________________________________________

 

FASE:   distrettuale  c        provinciale   c            regionale  c          nazionale  c 

 

DISCIPLINA ____________________________________  MAS. c               FEM.  c 

 

DOCENTE ACCOMPAGNATORE ________________________________________________

 

ALUNNI/E  PARTECIPANTI:

                 cognome e nome                                                                                  data di nascita             

 

1) ______________________________                   _____/_____/_____                  

 

2) ______________________________                  _____/_____/_____                   

 

3) ______________________________                   _____/_____/_____                  

 

4) ______________________________                  _____/_____/_____                  

 

5) ______________________________                  _____/_____/_____                  

 

6) ______________________________                  _____/_____/_____                  

 

7) ______________________________                  _____/_____/_____                  

 

8) ______________________________                  _____/_____/_____                  

 

9) ______________________________                 _____/_____/_____                  

 

10) ______________________________                _____/_____/_____                  

 

11) ______________________________                _____/_____/_____                  

 

12) ______________________________                _____/_____/_____                  

 

13) ______________________________                _____/_____/_____                  

 

14) ______________________________                _____/_____/_____                  

 

15) ______________________________                _____/_____/_____                   

 

Si dichiara che gli alunni sopraindicati sono iscritti e frequentanti la scuola ed in possesso del prescritto accertamento sanitario per la pratica sportiva non agonistica.

DATA ___________                                         TIMBRO SCUOLA                                              IL DIRIGENTE SCOLASTICO