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["colors桜台二丁目学童クラブ入会申請書[令和6年度分]"]
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[null,"令和5年度の放課後児童の広場事業(民間学童クラブ）を申請します。"]
[{"$nulls":8},"     ※太線の枠内に記入してください。"]
["申請日",null,null,null,"　令和　　　　　　　　年　　　　　　　　月　　　　　　　　　日"]
["申請先                 　　　　　　",null,null,null,"colors桜台二丁目学童クラブ",{"$nulls":10},"専願・併願",null,null,null,"colors専願で申請している"]
[{"$nulls":19},"他の学童と併願している"]
["児童氏名",null,null,null,"フリガナ",{"$nulls":19},"性別"]
[{"$nulls":5},"（平成　　　年　　　月　　　日生）"]
["小学校名・\n学年",null,null,null,"（令和５年４月から）",{"$nulls":8},"立",{"$nulls":4},"小学校　",null,null,"（新）　　　　　　　",{"$nulls":4},"年生"]
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["保護者氏名",null,null,null,"フリガナ"]
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["住所",null,null,null,"マンション名・方書きにもフリガナをお願いします。"]
[{"$nulls":4},"郵便番号",null,null,null,"フリガナ"]
[{"$nulls":4},"〒",null,null,null,"練馬区"]
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["電話番号",null,null,null,"自宅",null,null,"          （          )",{"$nulls":8},"携帯（父・母）",null,null,null,"          （          )"]
[{"$nulls":4},"勤務先(日中連絡可能な場合のみご記入ください。）",{"$nulls":8},"名称",{"$nulls":6},"          （          )"]
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["父母の状況",null,null,null,"父",{"$nulls":11},"母"]
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["父母の氏名",null,null,null,"フリガナ",{"$nulls":11},"フリガナ"]
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["同居・別居",null,null,null,"別居の場合は住所を記入してください。"]
[{"$nulls":4}," 同居 ・",null,"別居（",{"$nulls":8},"）"," 同居 ・",null,"別居（",{"$nulls":8},"）"]
["保育を必要と\nする理由",null,null,null,"該当する理由を選んで○印をつけてください。"]
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[{"$nulls":4},"・","該当者なし",{"$nulls":4},"・","看護・付添い",{"$nulls":4},"・","該当者なし",{"$nulls":4},"・","看護・付添い"]
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[{"$nulls":4},"・","就労",{"$nulls":4},"・","その他",{"$nulls":4},"・","就労",{"$nulls":4},"・","その他"]
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[{"$nulls":4},"・","疾病",{"$nulls":10},"・","疾病"]
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["［施設記入欄］（この下には記入しないでください）"]
["特記事項"]
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[]
["受付年月日",null,null,null,"令和　　　年　　　月　　　日",{"$nulls":7},"受付施設",null,null,"colors桜台二丁目学童クラブ",{"$nulls":7},"担当"]
["入会希望児童の状況"]
["児童氏名",{"$nulls":4},"フリガナ"]
[]
[]
["通っていた保育園      ・幼稚園",{"$nulls":12},"　　　　　　　　　　　　　　　　　　　　　　保育園・幼稚園"]
["特別な配慮の必要な児童について"]
["アレルギー・既往症・持病",{"$nulls":4},"特に配慮が必要なアレルギーや既往症、持病について記入していただき、申請の際にご相談ください。"]
[{"$nulls":6},"無　・",null,"有　（具体的に：　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
["児童の出席\n予定日数\n",{"$nulls":4},"出席予定日数をご記入ください。"]
[{"$nulls":5},"１週間あたり",{"$nulls":6},"日×",null,"４週＝",{"$nulls":5},"日"]
["児童のオプション　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　利用予定",{"$nulls":4},"無　・　有",{"$nulls":4},"     早朝",{"$nulls":4},"月極（オプション）",{"$nulls":5},"単発（スポット）"]
[{"$nulls":10},"     夜間",{"$nulls":4},"月極（オプション）",{"$nulls":5},"単発（スポット）"]
["※オプションは原則一年間（早朝は一日保育日）の継続利用になります。"]
["兄弟姉妹の状況",{"$nulls":4},"本人を除く兄弟姉妹について記入してください。"]
[null,null,"氏名・年齢（令和5年4月1日現在）",{"$nulls":7},"学校・保育園・幼稚園（令和5年4月から）",{"$nulls":10},"学童（民間）クラブ申請状況"]
[{"$nulls":8},"（","歳）","（新）",{"$nulls":4},"学校・保育園・幼稚園",{"$nulls":4},"年",null,null,null,"学童クラブに申請"]
[{"$nulls":8},"（","歳）","（新）",{"$nulls":4},"学校・保育園・幼稚園",{"$nulls":4},"年",null,null,null,"学童クラブに申請"]
[{"$nulls":8},"（","歳）","（新）",{"$nulls":4},"学校・保育園・幼稚園",{"$nulls":4},"年",null,null,null,"学童クラブに申請"]
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["祖父母の状況",{"$nulls":25},"施設記入"]
[null,null,"氏名・年齢（令和5年4月1日現在）",{"$nulls":7},"住所（市区町村まで）",{"$nulls":10},"勤務先",{"$nulls":4},"内","外"]
["父方","祖父",{"$nulls":6},"（","歳）","該当者なし・同居・別居（　　　　　　　　　　　　　　　　　　　）"]
[null,"祖母",{"$nulls":6},"（","歳）","該当者なし・同居・別居（　　　　　　　　　　　　　　　　　　　）"]
["母方","祖父",{"$nulls":6},"（","歳）","該当者なし・同居・別居（　　　　　　　　　　　　　　　　　　　）"]
[null,"祖母",{"$nulls":6},"（","歳）","該当者なし・同居・別居（　　　　　　　　　　　　　　　　　　　）"]
[]
["［施設記入欄］（この下には記入しないでください）",{"$nulls":24},"計"]
["①",{"$nulls":4},"②","父",null,null,null,"③",{"$nulls":4},"④",{"$nulls":4},"⑤"]
[{"$nulls":6},"母"]