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清江國小六年級6/14(二)~6/17(五)《遠距教學規劃期間基本照顧服務需求》申請表
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學生班級/座號(填寫範例：101/30 )
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學生姓名(請填中文全名)
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到校參加基本照顧班需求天數
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6/14(二)
6/15(三)
6/16(四)
6/17(五)
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6/14(二)~6/17(五)午餐需求
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學校營養午餐
自備
緊急聯絡人姓名/關係(填寫範例：王大明/父親)
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緊急聯絡人連絡電話
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學童上下學方式(選其他，請加註說明)
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家長接送
安親班接送
Other:
其他備註事項(無則免填)
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