fisa inscriere cursuri

FORMULAR DE ÎNSCRIERE

Nume şi prenumele copilului: ______________________________________________________

Adresa:  _________________________________________________________________________

Vârsta copilului: ____________________________________________________

Numărul de telefon de acasă: ______________________________________________________

Adresa de email: _________________________________________________________________

Numărul de telefon mobil:            _________________________________________________________

Numele părinţilor:  

            Mama: ____________________________________________________________________

            Telefon mobil: _____________________________________________________________

            Tata:   _____________________________________________________________________

            Telefon mobil: _____________________________________________________________

Persoana care se va contacta în caz de urgenţă: _______________________________________

            Telefonul: fix: ____________________      mobil: ____________________

Informaţii medicale: ______________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Comentarii: ______________________________________________________________________

_________________________________________________________________________________

Data: __________________                                      Semnătura: ____________________

La aceste date se adauga adeverinta medicala (apt pentru efort fizic) in cazul participarii la cursul de dans popular.