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スポーツ保険申請
各位
下記、入力をお願いいたします。
①事故の日時、場所、状況説明
②傷害の内容
③医療機関名、治療期間(見込み)
④書類送付先
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お名前(お子様)
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事故の日時
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事故の場所
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状況説明
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傷害の内容(箇所、部位、怪我の名称等)ex右足首捻挫
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医療機関名
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医療機関名(複数あれば)
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治療期間(見込み)
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郵便番号(書類送付先)
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住所(書類送付先)
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連絡先(保護者携帯)
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