APPLICATION FORM HOLIDAYS WITH NAMI FOUNDATION

APPLICATION FORM
HOLIDAYS WITH NAMI FOUNDATION
SUMMER 2014
Child name and surname……………………………………………………………………………………
Date and place of berth………………………………………………………………………………………
Address……………………………………………………………………………………….…….…….…
Identification number ……………………………….
Phone number (parent)………………………………
Name and address of School …………………………………………………………………………………
I commit to (please choose):
 bring and pick up child by myself
 I empower following person to bring and pick up my child:
….....................................................................................................
I declare that I know the general regulations of Holiday Classes, I accept these rules and I will inform my
child about these rules
……………………………………………………….
sign
I permit the NAMI Foundation to make photos of my child during the Holidays Classes and to use them for
documentation and information of the NAMI Foundation activities
…………………………………………………………..
sign
Fundacja Przyjaźni Polsko-Japońskiej NAMI, ul. Legnicka 65, 54-206 Wrocław
KRS 0000463568, REGON 022151911, NIP 894-304-66-75
Konto bankowe: BANK BGŻ 60 2030 0045 1110 0000 0315 2980
www.fundacja-nami.pl, e-mail [email protected]