UEB - Unio dos Escoteiros do Brasil

SIGUE - Sistema de Informaes e Gerenciamento de Unidades Escoteiras

12/TO - PARALELO 10

Ficha de registro individual

ASSOCIADO BENEFICIRIO
Nome completo:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Sexo:
Natural de:
UF:
Masculino
Feminino
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Data de nascimento:
_________/_________/____________

Escolaridade:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

Endereo:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Complemento:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

Bairro:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

Cidade:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Tel. Residencial:
|___|___|___|___|___|___|___|___|___|___|___|

N:
|___|___|___|___|___|

Tel. Comercial:
|___|___|___|___|___|___|___|___|___|___|___|

UF:
|___|___|

CEP:
|___|___|___|___|___|___|___|___|

Tel. Celular:
|___|___|___|___|___|___|___|___|___|___|___|___|___|

E-mail (importante):
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Profisso:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Local de trabalho:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
RG:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

rgo expedidor:
|___|___|___|___|___|___|___|___|___|

CPF:
|___|___|___|___|___|___|___|___|___|___|___|

Clube de servico:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Religio:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

RESPONSVEL LEGAL E ASSOCIADO CONTRIBUINTE

Nome completo do responsvel:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Parentesco: |___| Pai
|___| Me
|___| Tutor
Sexo:
Natural de:
UF:
Masculino
Feminino
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Data de nascimento:
_________/_________/____________

Escolaridade:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

Endereo:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Complemento:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

Bairro:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

Cidade:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Tel. Residencial:
|___|___|___|___|___|___|___|___|___|___|___|

N:
|___|___|___|___|___|

Tel. Comercial:
|___|___|___|___|___|___|___|___|___|___|___|

UF:
|___|___|

CEP:
|___|___|___|___|___|___|___|___|

Tel. Celular:
|___|___|___|___|___|___|___|___|___|___|___|___|___|

E-mail (importante):
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Profisso:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Local de trabalho:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
RG:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

23/10/15 10:04

rgo expedidor:
|___|___|___|___|___|___|___|___|___|

CPF:
|___|___|___|___|___|___|___|___|___|___|___|

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Autorizo a Unio dos Escoteiros do Brasil (UEB) EM TODOS OS SEUS NVEIS, sociedade civil sem fins lucrativos, declarada de Utilidade Pblica Federal,
inscrita no CNPJ/MF sob o n 33.788.431/0001-13, com sede na Rua Coronel Dulcdio, bairro gua Verde, Curitiba - PR, CEP 80.250-100, a utilizar-se das
imagens e voz minha, ou daquele que represento ou assisto, para a edio de filmes e fotos, outorgando-lhe todos os direitos de imagem relacionados, para
qualquer tipo de divulgao, publicidade e veiculao em todos e quaisquer meio de comunicao, a exclusivo critrio da Unio dos Escoteiros do Brasil, que
poder, ainda, reproduzir, editar, introduzir no mercado, armazenar, distribuir, executar, transmitir, criar trabalhos derivados e baseados nas imagens e
informaes disponibilizadas, para finalidade editorial, comercial, promocional, educacional, institucional, publicitria e todas as outras formas que venham a ser
passveis de utilizao.
Os associados beneficirios e contribuintes declaram que conhecem e concordam em cumprir a regulamentao interna da Unio dos Escoteiros do Brasil.
Declaro que as informaes acima foram por mim prestadas e so de minha inteira e total responsabilidade, especialmente o contedo e especificaes
descritos na ficha mdica.
___________ ____/____/_____
Associado Beneficirio

23/10/15 10:04

Associado Contribuinte/Escotista/Dirigente/Colaborador

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