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Viaje a Santa Fe 4° "c"
COMPLETAR EL SIGUIENTE FORMULARIO PARA CONTRATAR EL SEGURO PARA EL VIAJE A SANTA FE.
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NOMBRE DEL ALUMNO
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DNI
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NOMBRE DEL PADRE O TUTOR
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DNI
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EN CASO DE URGENCIAS COMUNICARSE CON
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TELÉFONO
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CUENTA CON OBRA SOCIAL
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SI
No
CUAL? INDIQUE NÚMERO DE AFILIADO
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TOMA ALGUNA MEDICACIÓN
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SI
No
CUAL?
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ES ALÉRGICA/O A ALGÚN MEDICAMENTO
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Sí
No
ESPECIFICAR
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OBSERVACIONES
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