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林安泰古厝【自助抓週2.0】報名表
林安泰古厝抓週活動，廣受家長喜愛。為服務更多新生兒家庭，特別推出【自助抓週2.0】，無須設籍臺北市即可報名。名額有限，歡迎大家報名！
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新生兒家庭資料填寫
請妥善並完整填寫，報名成功與否，將以簡訊通知。
新生兒姓名
*
Your answer
新生兒出生日期
*
僅限2019年11月至2020年2月出生新生兒才可報名
MM
/
DD
/
YYYY
家長姓名
*
Your answer
手機號碼
*
寫下格式請0911-111-111
Your answer
電子信箱
*
Your answer
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