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Por favor rellene este formulario y firme como padre o guardian – Please complete this form and sign as parent or guardian – Silvouplè (souple, tanprisouple) konplete fòmilè sa-a epi siyen tankou paran oswa gadyen (responsab) kitchen islands canada
¿Cómo supo de nosotros? ¿Quién le refirió? – How did you hear about us? Who referred you? – Kòman ou fè konnen nou la? / Ki moun ki rekòmande nou? / Ki moun ki voye ou?
Favor de identificar al amigo, escuela, iglesia, organización o templo kitchen islands canada de vodu – Please identify the friend, school, church, organization or voodoo temple – Silvouplè idantifye zanmi, lekòl, legliz, òganizasyon kitchen islands canada ak onfò
Información acerca de su hijo/a (Para ser completado por el padre o tutor) – Information about your child (To be completed by parent or guardian) – kitchen islands canada Enfòmasyon sou pitit ou (Se paran oswa gadyen timoun you ki pou konplete fòm sa-a)
Dirección; Ciudad; Estado; Teléfono de casa; Código postal; origen étnico – Address; kitchen islands canada City; State; House telephone; Postal code; ethnic backgrounds – Adrès; vil; eta; telefòn kay la; zòn postal; gwoup etnik timoun nan
Nombre del padre / guardian: Estado Civil; Casado; Soltero; Divorciado; Separado; Viudo – Name of parent / guardian: Marital status: Married; kitchen islands canada Single; Divorced; Separated; widowed – Non paran an / gadyen/responsab: Eta sivil: Marye, selibatè; divòse; separe; mari oswa madanm mouri (vef)
Ingresos del hogar / el número de miembros en el hogar – kitchen islands canada Household income kitchen islands canada / Number of members in the household – Konbyen kòb fanmi an fè / Konbyen moun k-ap viv nan kay la
El niño vive con (Comprobar si es el mismo que arriba): Nombre: Primer nombre; Segundo nombre; Apellido; Dirección; Número del teléfono; número de cellular kitchen islands canada – Child lives with (Check if same as above): Name: First name: Middle name; Last name; address; home phone ........
Historia kitchen islands canada Médica – Medical History – Istwa swen santé kitchen islands canada ¿Está su hijo bajo el cuidado de un médico ahora? – Is your child under a physician’s care now? – Eske pitit ou a gen yon doktè?
¿Su hijo ha estado hospitalizado? – Has your child been hospitalized? – Eske pitit ou a te entène? ¿Ha tenido su hijo una operación importante? – Has your child had a major operation? – Eske pitit ou a te fè yon operasyon? kitchen islands canada
¿Hay kitchen islands canada algo más que deberíamos saber sobre la salud de su hijo? Díganos por favor – Is there anything else we should know about the health kitchen islands canada of your child? Tell us please – Eske gen lòt bagay nou sipoze konnen sou santé pitit ou a? Di nou souple.
¿Es su hijo alérgico a algunos de los siguientes: Aspirina; Penicilina; codeine; acrílico; metal; latex; anestesias locales? – Is your child allergic to any of the following: Aspirin; Penicillin;
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Purchase this book for far less, $9.99 at Amazon /Kindle Direct Publishing Inspired by Rosa Parks's Courage and Sitting on the Bus (v.4) is an inspirational book of poetry that compels us to look back and forward to find signs of inspiration in our lives and current difficult times. This book of poetry has 100 new and selected poems published solely kitchen islands canada for your edification and uplifting. Find more at http://poetrybusinessblog.blogspot.com
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