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["岡山市立犬島自然の家 該当施設・宿泊・体験活動 利用者名簿\n（事前提出用）"]
[]
[]
["利用代表者氏名",null,null,null,null,null,null,null,null,"利用日","令和　　年　　月　　日～"]
[null,null,null,null,null,null,null,null,null,null,"令和　　年　　月　　日"]
[]
["№","氏　　名",null,null,null,null,"年齢","住　　所",null,null,"施設利用・\n体験活動","←項目をクリックするとチェックが入ります"]
[1,null,null,null,null,null,null,"〒",null,null,"\n　\n"]
[]
[null,"該当に○をつけてください",null,null,null,null,"歳","TEL"]
[null,"男","女","一般","大学生","高校生","中学生","小学生","未就学（4～6歳）","未就学（4歳未満）",null,"←該当について、項目をダブルクリックすると〇がつきます。再度ダブルクリックすると〇を消せます。"]
[null,"国籍※",null,null,null,null,null,null,"旅券番号※"]
[2,null,null,null,null,null,null,"〒",null,null,"\n　\n","←項目をクリックするとチェックが入ります"]
[]
[null,"該当に○をつけてください",null,null,null,null,"歳","TEL"]
[null,"男","女","一般","大学生","高校生","中学生","小学生","未就学（4～6歳）","未就学（4歳未満）",null,"←該当について、項目をダブルクリックすると〇がつきます。再度ダブルクリックすると〇を消せます。"]
[null,"国籍※",null,null,null,null,null,null,"旅券番号※"]
[3,null,null,null,null,null,null,"〒",null,null,"\n　\n","←項目をクリックするとチェックが入ります"]
[]
[null,"該当に○をつけてください",null,null,null,null,"歳","TEL"]
[null,"男","女","一般","大学生","高校生","中学生","小学生","未就学（4～6歳）","未就学（4歳未満）",null,"←該当について、項目をダブルクリックすると〇がつきます。再度ダブルクリックすると〇を消せます。"]
[null,"国籍※",null,null,null,null,null,null,"旅券番号※"]
[4,null,null,null,null,null,null,"〒",null,null,"\n　\n","←項目をクリックするとチェックが入ります"]
[]
[null,"該当に○をつけてください",null,null,null,null,"歳","TEL"]
[null,"男","女","一般","大学生","高校生","中学生","小学生","未就学（4～6歳）","未就学（4歳未満）",null,"←該当について、項目をダブルクリックすると〇がつきます。再度ダブルクリックすると〇を消せます。"]
[null,"国籍※",null,null,null,null,null,null,"旅券番号※"]
[5,null,null,null,null,null,null,"〒",null,null,"\n　\n","←項目をクリックするとチェックが入ります"]
[]
[null,"該当に○をつけてください",null,null,null,null,"歳","TEL"]
[null,"男","女","一般","大学生","高校生","中学生","小学生","未就学（4～6歳）","未就学（4歳未満）",null,"←該当について、項目をダブルクリックすると〇がつきます。再度ダブルクリックすると〇を消せます。"]
[null,"国籍※",null,null,null,null,null,null,"旅券番号※"]
[]
["※日本政府は、法令に基づき、「日本国内に住所を有しない外国人」の方の宿泊に際して、氏名・住所・連絡先等に加えて国籍及び旅券番号の記載を義務付けています。また、旅券の呈示及び写しを求めていますので、ご理解ご協力をお願いします。"]
["\n 利用者名簿をご記入いただき、申請書と一緒に利用日の１０日前までに郵送、\n ＦＡＸまたはメールで犬島自然の家までご提出ください。\n　"]
[null,"岡山市犬島自然の家"]
[null,"〒７０４－８１５３　岡山市東区犬島１１９－１"]
[null,"ＦＡＸ ０８６-９４７－９３０３"]
[null,"メール inujima@city.okayama.lg.jp"]