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FLORENTINUM
British Nursery & Preschool
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Online registraTION FORM
Name - Mother*
Surname - Mother*
Local Phone - Mother *
Date of Birth - Mother*
E-mail Address - Mother*
Name - Father*
Surname - Father *
Local Phone - Father*
Date of Birth - Father*
E-mail Address - Father*
E-mail Address - Invoicing (tuition, food)*
Name - Child*
Surname - Child*
Personal identification number or Passport Number - Child*
Gender - Child*
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Permanent Address in Prague - Family*
Date of Birth - Child*
Place of Birth - Child*
Residence Status - Child*
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Refuge Visa
Nationality - Child*
What languages does your child speak?*
Attendance begins
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Does your the child sleep after lunch?*
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Daily Routine
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Doctor´s Name, Phone and Address*
Prescriptions Medications
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C
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Medical Insurance Co.*
Illness or Conditions
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Asthma
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Ear Infestation
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G.M.Rubbela
Vaccination (immunization)*
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