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因應防疫需求 學生居家管理 資料建置單
為求快速提交衛生單位，請各位家長協助配合填寫。
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學生班級與學生座號(ex:一年一班1號 請輸入10101)
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學生姓名
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學生性別
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學生年齡*
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家長聯絡電話/手機
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學生出生日期
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MM
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DD
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YYYY
學生身分證號(居留證/護照)*
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居住(縣/市)
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居住(鄉/鎮/市/區)*
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居家隔離住址
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戶籍地址
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居家隔離陪同者(姓名 / 關係)
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居家隔離陪同者(出生日期)
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MM
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DD
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YYYY
居家隔離陪同者(身分證字號)
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緊急聯絡人姓名（勿填寫陪同學生居家隔離家長）
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緊急聯絡人電話（勿填寫陪同學生居家隔離家長）
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