PISCINA DE SALT CURS 2019-2020
NOM I COGNOM *
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DATA DE NAIXAMENT *
MM
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DD
/
YYYY
CURS ACADÈMIC (2019-2020) *
NÚMERO DE TARGETA SANITÀRIA *
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NOM DEL PARE *
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NOM DE LA MARE *
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TÉ AL.LÈRGIES ? *
EN CAS DE TENIR AL.LÈRGIES, QUINES?
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TELÈFONS DE CONTACTE *
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ETS SOCI DE L'AMPA?
QUIN DIA? *
QUIN HORARI? *
E-MAIL
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