SCUOLA / ISTITUTO ______________DI_

DATA DELL’EVENTO_________________________________________________________

FASE: promozionale

DISCIPLINA ____________________________________ MAS. FEM.

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, che appartengono alla stessa classe

e che i dati sopra riportati corrispondono al vero.

Il Dirigente Scolastico

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