UEB - Unio dos Escoteiros do Brasil

SIGUE - Sistema de Informaes e Gerenciamento de Unidades Escoteiras

4/PA - G.E. DO AR SANTOS DUMONT

Ficha de registro individual

Nome

Nmero de registro:

Sexo:

Nome abreviado (O nome preenchido neste campo ser impresso na

|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Masculino
Feminino
Data de nascimento:
Natural de:
UF:
_________/_________/____________
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Escolaridade
Srie:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Profisso
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Local de trabalho:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Endereo
N
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| |___|___|___|___|___|
Complemento:
Bairro
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Cidade
UF:
CEP:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
|___|___|
|___|___|___|___|___|___|___|___|
Tel. Res.:
Tel. Com.:
Tel. Cel.:
|___|___|___|___|___|___|___|___|___|___|___|
|___|___|___|___|___|___|___|___|___|___|___|
|___|___|___|___|___|___|___|___|___|___|___|
E-mail
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
RG:
rgo expedidor:
|___|___|___|___|___|___|___|___|___|___|___|___|___|
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
CPF:
Ano ingresso:
|___|___|___|___|___|___|___|___|___|___|___|___|___|
|___|___|___|___|
Tipo de registro:
|__| Incluso |__| Renovao |__| Retorno ao M. |__| Scio no registrado no ano

|__| Transferncia (do G.E. _____/_____) |__| Scio

Observaes ........................................................................................................................................................................................................
Dados da 1 funo
Categoria:

Ramo

Funo

|__| Beneficirio

|__| Dirigente

|__| Lobinho

|__| Assistente

|__| Diretor

|__| Local (GE)

|__| Benemrito

|__| Escotista

|__| Escoteiro

|__| Chefe de seo

|__| Instrutor

|__| Regional

|__| Benemrito/Honorfic

|__| Honorfico

|__| Snior

|__| Comisso de tica e disciplina

|__| Clube da Flor de Lis

|__| Pais/Responsveis |__| Pioneiro

|__| Contribuinte

Nvel:

|__| Comisso fiscal

|__| Diretor
(Somente para membros adultos que desempenham uma segunda funo)
Ramo
Funo

Dados da 2 funo
Categoria:

|__| Nacional

Nvel:

|__| Beneficirio

|__| Dirigente

|__| Lobinho

|__| Assistente

|__| Diretor

|__| Local (GE)

|__| Benemrito

|__| Escotista

|__| Escoteiro

|__| Chefe de seo

|__| Instrutor

|__| Regional

|__| Benemrito/Honorfic

|__| Honorfico

|__| Snior

|__| Comisso de tica e disciplina

|__| Clube da Flor de Lis

|__| Pais/Responsveis |__| Pioneiro

|__| Nacional

|__| Comisso fiscal

|__| Contribuinte
|__| Diretor
Clube de servio:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Religio
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Plano de sade:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

|__| Sim, o responsvel deseja receber a credencial escoteira avulsa opcional

Nome completo do responsvel:

R$

|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Sexo:

Nome abreviado (O nome preenchido neste campo ser impresso na

Masculino
Feminino |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Data de nascimento:
Natural de:
UF:
_________/_________/____________
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Escolaridade
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Profisso
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Local de trabalho:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Endereo
N
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| |___|___|___|___|
Complemento
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

Bairro
|___|___|___|___|___|___|___|___|___|___|___|___|___|

Cidade
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Tel. Res.:
|___|___|___|___|___|___|___|___|___|___|___|

Tel. Com.:
|___|___|___|___|___|___|___|___|___|___|___|

UF:
|___|___|

CEP:
|___|___|___|___|___|___|___|___|

Tel. Cel.:
|___|___|___|___|___|___|___|___|___|___|

E-mail
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
N Identidade:
|___|___|___|___|___|___|___|___|___|___|___|___|___|

Orgo expedidor:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

CPF:
|___|___|___|___|___|___|___|___|___|___|___|___|___|
|__| Sim, a me deseja receber a credencial escoteira avulsa opcional
Nome completo da me:

R$ 10,00

|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Sexo:

Nome abreviado (O nome preenchido neste campo ser impresso na

Masculino
Feminino |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Data de nascimento:
Natural de:
UF:
_________/_________/____________
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Escolaridade
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Profisso
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Local de trabalho:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Endereo
N
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| |___|___|___|___|
Complemento
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

Bairro
|___|___|___|___|___|___|___|___|___|___|___|___|___|

Cidade
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Tel. Res.:
|___|___|___|___|___|___|___|___|___|___|___|

Tel. Com.:
|___|___|___|___|___|___|___|___|___|___|___|

UF:
|___|___|

CEP:
|___|___|___|___|___|___|___|___|

Tel. Cel.:
|___|___|___|___|___|___|___|___|___|___|

E-mail
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
N Identidade:
|___|___|___|___|___|___|___|___|___|___|___|___|___|

Orgo expedidor:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

CPF:
|___|___|___|___|___|___|___|___|___|___|___|___|___|
Ateno: Ao preencher esta ficha voc estar, automaticamente, concordando com a cesso do uso do Direito imagem em campanhas institucionais
promovidas pela UEB, sem que isto reflita em danos morais de acordo com o previsto no Cdigo Civil, art. 11 ao art. 20.
Assinatura do Responsvel legal ou Participante

Data: ________/________/______________