Přihláška Na Tábor 2012

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Pihlka na tbor s Centrem pro rodinu Jalub 29.7. 4.8.

2012

Jmno: Pjmen: Datum narozen: Bydlit: Otec: Kontakt na rodie: Tel: e-mail: Matka: Tel: e-mail: Um plavat: Velikost trika:

Zdravotn pojiovna:

Zdravotn omezen:

Povahov vlastnosti:

Zjmy a zliby:

Vyplnnm tto pihlky dvm souhlas s pouitm uvedench osobnch daj pro poteby dn innosti Centra pro rodinu Uhersk Brod v souladu s pslunm zkonem 101/2000 Sb. v platnm znn.

V .. Dne: .

Podpis rodi (zkonnho zstupce): .......

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