주민등록번호 없는 보육아동 등록 신청서

Application Form for Admission

이름 생년월일 성별
Name Date of birth Gender

종일( ), 시간연장
입소일
출생순위 보육시간 ( ),
Desirable date of
Birth Order Time to care 24시간( ), 휴일보
enrollment
아 동 육( )
Child 외국인등록번 여권번호 의료급여전산
호 Alien
Passport
Registration 관리번호
number
number

국적
주소Adress
Nationality

상해보험 가입여
반구분 (반명 기입)
부

전화번호
부 성명 모 성명 Phone number
보호자
Father’s Mother’s
Parent 휴대전화번호
name name
cell-phone
number

어린이집명 포스코나라 어린이집 주소 인천 연수구 컨벤시아대로 42번길77

대표자 성명 문정숙 어린이집 전화 032)831-8651

우리 어린이집에 입소한 주민등록번호 없는 보육아동에 대하여 상기와 같이 보육통합정보시스템

에
등록을 신청합니다.

20 년 월 일

원장성명 전미숙

연수구청장 귀하
※ 첨부서류
외국인등록증, 여권, 출생증명서 등 출생을 증명하는 서류 1부


(Application for admission) 입소대기신청서

Below child apply to enroll to this nursery(아래의 영유아가 귀 어린이집에 입소대기 신청하고자합니다.)
To Director of nursery(포스코나라어린이집원장 귀하)
Month(월) Day(일) Year(년)
Applicant(신청인) : (signature)(인)

생년월일
이름 성별
Date of
Name Gender
birth
□기본(basic day care
희망 입소일
보육시간
출생순위 (07:30 ~ 16:00)
Time to Desirable date
Birth Order □ 연장(Extendedchild
care of enrollment
care
대상
영유
(16:00 ~19:30)
아
Target 외국인등록 여권번호
번호 Alien 의료급여전산
Child Passport
Registration 관리번호
number number
국적
Nationality

주소Adress

입소 분류 □무상임대(Free rent) ( )
Classify □일반 외국인(Ordinary foreign child)
이름(Name) 관계(Relationship)

신청인 외국인등록
번호 Alien 전화번호(Mobile)
보호자 Registration
Applicant number
Guardian 비상연락 이름(Name) 관계(Relationship) 전화번호(Mobile)
Emergency
Contact
해당사항에 반드시 체크해 주세요( Please mark in the applicable box )
응급처지동의서 □필요시 119 연락(Call 119)
Emergency
□기관지정 의료기관(○○○병원)(Appointed hospital(○○○hospital)
Treatment
Agreement □보호자지정 의료기관(Appointed hospital by parents( )

귀가 동의서 □다음과 같이 귀가를 동의 합니다.( ※보호자 동행)

(I agree to pick up like below ( ※ accompany with parents )
Drop-off & Pick-
□등원시간(Drop off time) :
up authorization
form □하원시간(Pick up time) :

□ 있음(Have allergy)
- 유발식품(Caused food) :
- 알레르기 증상(Symptom) :
알레르기
- 대체가능식품(Alternative food) □제거식(removal food) □대체식(Alternative food)
Allergies
- 대체식품제공여부(Alternative food Yes or No for alternative food?)
□가정(Home) / □어린이집(Nursery)
□없음(No)
운영 수요조사 □ 기본보육(Basic childcare)(07:30 ~ 16:00)
 Demand survey □ 연장보육(Extended child care)(16:00 ~19:30)
for the Operating
□야간연장(Night child care)(19:30~21:30)
plan of Nursery
School
※ Additional document: Alien Registration Card(Father, Mother. Target child)
※ If no ARC(Certificate of Korean residency,Passport, birth certificate etc.)
※ 첨부서류: 외국인등록증(부, 모. 대상아동) ※ 외국인 등록증 없을시(임시거소증, 여권, 출생증명서 등)

Consent form to gather personal information to put on the waiting list

(Offline)(개인정보동의서)

○ Agreement on the collection and use of personal information

Based on the article 15 and 17 of 「Personal Information Protection Law」, the Article 19,22,27,34-3,34-4 of 「Child
care Protection Law」, and the article 18, 35-3,35-4,35-6 of the same law, I-Sarang child care portal site requires
the personal information to put a child on the waiting list as follows:

Use of personal
Purpose of personal information
Required personal information information and holding
collection and utilization
period

Parent name, Child name, Address, Put a child on the waiting list in I-
Semi-permanent
Contact number Sarang child care portal

* Parents may reject the collection and the use of optional items and, in the case of rejection, there will be
a limit on the use of services.

□ Agree □ Disagree

○ Agreement on the collection and use of inherent distinctiveness information.

I-Sarang child care portal site requires the inherent distinctiveness information to put a child on the waiting list
based on Article 24 of 「Personal Information Protection Law」, and Article 26-3 of 「Child care Protection Law」.

Purpose of using and collecting Use of inherent

Full details of inherent
inherent distinctiveness distinctiveness information
distinctiveness information
information and holding period

Put a child on the waiting list in I-

Alien registration numbers of family Semi-permanent
sarang child care portal site

* The parent may reject the collection and the use of optional items. In the case of rejection, there will be a
limit on the use of services.

□ Agree □ Disagree
I confirm the details and agree with the information related to the collection and utilization of personal

information.

20 . . .

Child Name :

Parent Name : (Signature)

Emergency treatment agreement(응급처치동의서)

Class Name Date of birth

Sex Male / Female Name

I hereby give permission for my child/children ................................................. to be given emergency treatment

(first aid and CPR) by a qualified staff member. I also give my permission for my child/children to be

transported by ambulance, aid car, or staff car to an emergency center for treatment.

20 . .

Parent name： (Signature)

1. We will contact parents first in the event of accidents.

Time
Number Relationship (Available time to Phone number Memo
contact)
1 Mother

2 Father

2. List at least two people who can be contacted in an emergency if the parent cannot be reached.

Number Relationship Name Phone number Memo

3. We will call 119, if it is needed.

(We will transport a child in the appointed hospital of nursery school or hospital that parents
designate.
 Therefore, If you want to designate a hospital, please write it below )

Name of hospital : ① , ②

4. After transporting, a child can have proper treatment quickly according to health insurance

information that you give below.

Type of health insurance
Number

Institution

I have read and fully understand the contents of this document. I agree to the terms and conditions
stated above.

20 . . . Parent name : (Signature)

포스코나라 NURSERY SCHOOL

◎ Please make sure to date and parent sign this document in the space above.

◎ Please keep us advised of any changes to your situation.

Drop-off & Pick-up authorization form(귀가동의서)

※ The parent's signature and date of completion must be written. (Other guardian's name must be written)

Gender
Child’s
Class
name Male ▢ Female ▢

The following person/people have permission to pick up my child from school on a regular basis. We will keep
you advised of any changes in advance.

■ Period : 2022. March. 01. ~ 2023. Februery. 28.

Division Means of commuting Time

Drop off ☐ Walking ☐Car ☐Other( )

Pick up ☐ Walking ☐Car ☐Other( )

※ If this schedule changes, I must notify the nursery school in advance.

■ Parents’ names & relationship to a child

Name Relationship Contact Number 1 Contact Number 2 Note

※ If a guardian is changed due to academy or other matters, a teacher must contact parents via
phone or Kids Note. Parents are responsible for the accident. (In case of change of contact
number, etc. must be notified to the homeroom teacher.)

* Pick-up role*
Your child will be released only to those who are on the list.

* In the case of the parent collecting a child

- In order to assure the safety of your child, we ask that you sign your child in and out each day.
The classroom registers are on the wall of the lobby as you enter the nursery school. After signing-in, make verbal

contact with a teacher in order for us to know that your child has arrived or left.

- If someone other than the above named individual is to pick-up a child, permission through a phone call or

noticing on Kids note must be made in advance prior to the pick up time.

* Even though parents want a child to go back home alone, we do not allow it.

* Only adults can pick-up a child. (Minors are not allowed.)

I understand this form gives permission to the above named individuals to pick-up my child on the stated days
only.

20 . . . Parent’s name : (Signature)

포스코나라 NURSERY SCHOOL

 Demand survey for the Operating plan of Nursery School
(어린이집 운영계획 수립을 위한 수요조사서)

Class Child Name Date of Birth

Extended child Night time extended child

Basic child care
Desire time to take care care
(7:30 ~ 16:00)
care of children (16:00 ~ 19:30) (19:30 ~ 24:00)
(Please tick √)

Pick-up time Drop-off time

Desire time to pick-up &
Drop-off

The way of dropping off □Individual dropping off and picking up

and picking up □The others( )

※ If you want to apply for the night time extended child care,
Note please fill in the application form.
※ Apply the automated attendance system

Notice
※ Please be sure to read the following information.

○ If you want to use the extended child care less than 10 hours per month after 17:00, it is
recommended to use the basic child care.
○ If parents want to stop using the extended child care, they have to inform it to the nursery
school.
○ Time will be calculated by automated attendance system.
※ Parents will pay for additional purchases when missing cards.

As shown above, I submit a demand survey for planning the operation of nursery school.

Parent name (Signature)

20 . . .

○○○ NURSERY SCHOOL

 Questionnaire for allergies (Food Safety Management Division)(알레르
기조사서)

■ Please check child's allergies

No Dermatitis Asthma Hives Alimentary Allergy Anaphylaxis

Types allergy Rhinitis

■ Has your child suffered from an allergy (except food poisoning) in the past year?
[ ] No [ ] Yes (If yes, please check the appropriate boxes below.)
■ If your child has an allergy, how would you like Suntree to manage meals and snacks?
[ ] Bring their own lunch box
[ ] Offer the meal but allergic foods should eliminated from the diet
[ ] Offer the meal without specific ingredient
[ ] Provide alternative meals (e.g children who have egg allergy can eat another protein foods with same nutritions)
[ ] The others (fill in here : )
■ Do you restrict the food for treatment of food allergic just in case?
( )No ( )Yes ⇒ What kind of food do you restrict?
□ egg □ milk □ bean □ peanut □ wheet □ millet □ beef □ chicken □ pork □ sesame
□ Nut(walnut, almond, pine nut etc.) □ crustacean(shrimp, crab, crawfish , oyster etc.) □ Fruit(peach, melon, watermelon,
kiwi, apple, orange, banana, manggo, tomato etc.) □ Vegetable(salary, carrot, mustard, garlic, brocoli, potato, onion, black
pepper etc.)
□ the others( detail : )
■ Have you experienced symtom caused by food allergic(except food poisoning) in a year lately?
( )No ( )Yes(you can double check) : If yes, please check in the boxes below.
■ How do you want nursery to manage meals and snacks related in food allergic?
Foods that cause allergies Symtom caused by food allergic
□Atopic dermatitis □Hives □Swollen on Face, eyes ,lips
□ egg □Vomiting,diarrhea, Stomachache □Asthma(cough, wheezing)
□Respiratory difficulty, cyanosis □Mental deterioration □Other details
□Atopic dermatitis □Hives □Swollen on Face, eyes ,lips
□ milk □Vomiting,diarrhea, Stomachache □Asthma(cough, wheezing)
□Respiratory difficulty, cyanosis □Mental deterioration □ Other details
□Atopic dermatitis □Hives □Swollen on Face, eyes ,lips
□ bean □Vomiting,diarrhea, Stomachache □Asthma(cough, wheezing)
□Respiratory difficulty, cyanosis □Mental deterioration □ Other details
□Atopic dermatitis □Hives □Swollen on Face, eyes ,lips
□ peanut □Vomiting,diarrhea, Stomachache □Asthma(cough, wheezing)
□Respiratory difficulty, cyanosis □Mental deterioration □Other details
□Atopic dermatitis □Hives □Swollen on Face, eyes ,lips
□ wheet □Vomiting,diarrhea, Stomachache □Asthma(cough, wheezing)
□Respiratory difficulty, cyanosis □Mental deterioration □Other details
□Atopic dermatitis □Hives □Swollen on Face, eyes ,lips
□ millet □Vomiting,diarrhea, Stomachache □Asthma(cough, wheezing)
□Respiratory difficulty, cyanosis □Mental deterioration □Other details
□Atopic dermatitis □Hives □Swollen on Face, eyes ,lips
□ meat
□Vomiting,diarrhea, Stomachache □Asthma(cough, wheezing)
beef, chicken, pork)
□Respiratory difficulty, cyanosis □Mental deterioration □Other details
□Atopic dermatitis □Hives □Swollen on Face, eyes ,lips
□ esame □Vomiting,diarrhea, Stomachache □Asthma(cough, wheezing)
□Respiratory difficulty, cyanosis □Mental deterioration □Other details
□Atopic dermatitis □Hives □Swollen on Face, eyes ,lips
□ nut
□Vomiting,diarrhea, Stomachache □Asthma(cough, wheezing)
(walnut, almond, pine nut etc.)
□Respiratory difficulty, cyanosis □Mental deterioration □Other details
□ crustacean □Atopic dermatitis □Hives □Swollen on Face, eyes ,lips
(shrimp, crab, crawfish , oyster etc.) □Vomiting,diarrhea, Stomachache □Asthma(cough, wheezing)
 □Respiratory difficulty, cyanosis □Mental deterioration □Other details

□ Fruit □Atopic dermatitis □Hives □Swollen on Face, eyes ,lips

(peach, melon, watermelon, kiwi, apple, □Vomiting,diarrhea, Stomachache □Asthma(cough, wheezing)
orange, banana, manggo, tomato etc.) □Respiratory difficulty, cyanosis □Mental deterioration □Other details

□ Vegetable □Atopic dermatitis □Hives □Swollen on Face, eyes ,lips

(salary, carrot, mustard, garlic, brocoli, □Vomiting,diarrhea, Stomachache □Asthma(cough, wheezing)
potato, onion, black pepper etc.) □Respiratory difficulty, cyanosis □Mental deterioration □Other details
□Atopic dermatitis □Hives □Swollen on Face, eyes ,lips
□ Fish (mackerel etc.) □Vomiting,diarrhea, Stomachache □Asthma(cough, wheezing)
□Respiratory difficulty, cyanosis □Mental deterioration □Other details
( ) Prepare personal lunch box, snacks.
( ) Want be provided meal except the food caused allergic
( ) Want be provided dish without the allergic food.
(For example, when the stir fried almond anchovy is menu, child can choose the dish which cooked in advence)
( ) Provided alternative food.
(For example, Children can choose another protein food as alternative food of egg.
( ) The others (Please write directly :