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["大会・講習会　参加関係者　健康状態確認シート",{"$nulls":33},"花巻市バドミントン協会"]
[null,null,"チーム・学校名"]
[null,null,"記載代表者氏名",{"$nulls":21},"記入日）"]
[null,null,"住　　　　所",{"$nulls":22},"令和",null,"年",null,"月",null,"日"]
[null,null,"連絡先（電話番号）"]
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[null,null,"※本用紙を記入するときにはメールや電話などの方法で聞き取りを行い、接触の機会を減らし記入するようにしてください。"]
[null,null,"※本用紙で提出していただきました個人情報は本大会以外には使用しません。また、所定の保管期間後には適切に処分いたします。"]