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Page 1: Ficha inscriçao ctl 2012

Nome: _______________________________________________________________________________________ nº de contribuinte ___________________________

Data de nascimento:_______/_______/___________ ano escolar:____________ turma:___________ nº cartão utente:______________________

Morada:________________________________________________________________________________________________________________________________________

____________________________________________________________________Localidade:________________________________________________________________

PESSOA RESPONSÁVEL (encarregado de educação)

Nome: ________________________________________________________________________ _____________ ___________________

Grau de parentesco:________________________________ contactos:________________________/________________________/________________________

Profissão:____________________________ mail:________________________________________________________________________________________________

Morada:________________________________________________________________________________________________________________________________________

____________________________________________________________________Localidade:________________________________________________________________

OUTROS CONTACTOS

Nome:________________________________________________________Parentesco:__________________telefone:____________________________________

Nome:________________________________________________________Parentesco:__________________telefone:____________________________________

AUTORIZAÇÃO DE SAÍDA

Nome:_______________________________________________________________Nome:___________________________________________________________________

Nome:_______________________________________________________________Nome:__________________________________________________________________

CUIDADOS ESPECIAIS

Doenças:____________________________________________________________Alergias:_______________________________________________________________

Restrições Alimentares:____________________________________________________________________________________________________________________

Outras informações consideradas de interesse:_____________________________________________________________________________________

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T.P.C. Faz sempre Só à sexta Sempre que queira

Queijas, ____________ de____________________________________de ________________

O Responsável ____________________________________________________________________________________

Observações:_________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________________________

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____________________ Sócio nº

CENTRO TEMPOS LIVRESFicha de inscrição

Somos pelas crianças.Rua de S. Romão, 1, 2790-435 Queijas - Tel APEE [email protected] - Cont. nº 506.381.293