Gradinita S.C. SELMA SALES S.R.L.

J40/9649/08.08.2011; CUI 28970547;

Sediu: Str. Sf. Treime, Nr 28, Sector 2, Bucuresti

ING Bank - IBAN: RO16 INGB 0000 9999 0620 5907

FISA DE INSCRIERE-CASTELUL COPIILOR

Numele si prenumele copilului____________________________________________________________

Data nasterii___________ Domiciliul_______________________________________________________
Prenumele mamei__________________________Prenumele tatalui______________________________
Ocupatia mamei___________________________Ocupatia tatalui________________________________
CI Serie si Nr / Mama Tatal .
CNP/ Mama Tatal .
Telefon mama_____________________________Telefon tata__________________________________ .
Mail mama________________________________E-mail Tata___________________________________.
Programul optat________________________________________________________________________.
Date de contact in caz de urgenta (alte persoane decat parintii): .
.
Alte specificatii referitoare la persoanele autorizate sa ia copilul
______________________________________________________________________________________
Persoane autorizate sa ia copilul (cu telefon, date contact)___________________________________
______________________________________________________________________________________
(se va atasa copie a actelor de identitate in cazul in care sunt alte persoane decat parintii)

Frati / susori - prenume, data nasterii: .

Optionale:_____________________________________________________________________________

DATE EDUCATIONALE: Gradinita sau crese frecventate anterior ( Nume institutie / Localizare /
Perioada): _____________________________________________________________________________
______________________________________________________________________________________
Alte limba vorbita daca este cazul:_________________________________________________________
Inclinatii native si hobby-uri:______________________________________________________________
De unde ati aflat de Gradinita: ____________________________________________________________

Probleme ale copilului care considerati a fi mentionate (boli, alte probleme) :

______________________________________________________________________________________
______________________________________________________________________________________
Intoleranta la anumite alimente____________________________________________________________
______________________________________________________________________________________
Alergii_________________________________________________________________________________
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Prezenta fisa de inscriere se completeaza in doua exemplare, cate una de fiecare parte.

Gradinita Castelul Copiilor

S.C. Selma Sales S.R.L. DATA, REPREZENTANT LEGAL,