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ESPAI JOVE JUNEDA
INICI 19/11/22
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DADES DE L'ADOLESCENT
NOM
*
Your answer
COGNOMS
*
Your answer
DATA NAIXEMENT
*
MM
/
DD
/
YYYY
NÚM. CATSALUT
*
Your answer
DNI
*
Your answer
TELÈFON DE CONTACTE
*
Your answer
DADES DEL PARE/MARE O TUTOR/A LEGAL
NOM
*
Your answer
COGNOMS
*
Your answer
DNI
*
Your answer
TELÈFON DE CONTACTE
*
Your answer
AUTORITZACIÓ DRETS D'IMATGE
*
SÍ
NO
AUTORITZO AL MEU FILL/A A PARTICIPAR A L'ACTIVITAT
*
SÍ
NO
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