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[null,null,null,"　　　　　平成２８年度　家庭調査票","   家　　庭　　調　　査　　票"]
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[null,"　　　　　　※本票は、お子さんの特性に配慮した支援を行うとともに、運営に必要な事項を確認するためのものです。"]
[null,"　　　　　　※クラブを利用する児童について個別にご記入下さい。"]
[null,"　　　　　　※本票の提出後、お子さんの状況等に変更が生じた際には、速やかにクラブに連絡してください。"]
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[null,null,"（ふりがな）"]
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[null,null,"（ふりがな）"]
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[null,"利用方法に関する","※　曜日などにより利用方法（迎えの時間・利用時間等）が異なる場合は、以下に詳しくご記入下さい。"]
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[null,"　　　及び"]
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[null,"＜家族構成＞"]
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[null,"＜その他＞"]
[null,null,"※お子さんの様子（性格・こだわり・好き嫌い等）についてクラブに伝えておくべき事項があればご記入下さい。"]
[null,"その他クラブへの"]
[null,"伝達事項"]

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[null,null,null,"　　　　　平成２８年度　家庭調査票","   家　　庭　　調　　査　　票"]
[]
[null,"　　　　　　※本票は、お子さんの特性に配慮した支援を行うとともに、運営に必要な事項を確認するためのものです。"]
[null,"　　　　　　※クラブを利用する児童について個別にご記入下さい。"]
[null,"　　　　　　※本票の提出後、お子さんの状況等に変更が生じた際には、速やかにクラブに連絡してください。"]
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[null,"氏名・続柄・時間","氏名",null,null,"　　続柄（　　　　　　　）　　　時間　　　　　　　　　　時　　　　分頃"]
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[null,"補足事項"]
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[null,"＜家族構成＞"]
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[null,"　　家族構成"]
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[null,"＜その他＞"]
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[null,"その他クラブへの"]
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