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Children Basic Information
Name & Family Name :
Father Name :
ID Card No :
Birthday Date & Place :
Birthday Date :
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
Birthday Place :
Family Information
Relative
Name & Family Name
Birthday Date
Education
Job
Phone No. (Job)
Cell No.
Leaving With Child
Relative
*
Select
Father
Mother
Brother
Sister
Other
Name & Family Name
Birthday Date
Education
Job
Phone No. (Job)
Cell No.
Leaving With Child
*
Select
Yes
No
The person how can receive the children in emergency
Name & Family Name
Relative
Phone No.
Name & Family Name
Relative
Phone No.
Name & Family Name
Relative
Phone No.
Name & Family Name
Relative
Phone No.
Child Entry & Exit
Chile Entry Time :
Child Exit Time :
Would you to use the kindergarten's transportation service?
Yes
No
Address & Phone No. :
Child Medical Information
Blood Type :
Birth Type :
NVD
Caesarean section
Nutrition :
Dry Milk
Breast feeding
If feeding was by both two type, on which age dry milk was replaced by breast feeding?
- None -
1 year
2 year
3 year
4 year
5 year
6 year
7 year
8 year
Diseases that child are affected :
Measles
Chickenpox
Mumps
Pertussis
Diphtheria
Smallpox
Rheumatism
Tetanus
Typhoid fever
High fever
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