FICHA DE INSCRIPCION

Nombre Completo (Ambos nombres Ambos Apellidos)

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Telfono: _________________ Colegio-curso:
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Direccin:
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Tomas medicamentos Cul? A qu hora?:
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Madre:
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Telfono y/o celular:
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Direccin:
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Padre:
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Telfono y/o celular:
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Direccin:
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Invitado por:
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