Skrįningarblaš ķ Ęvintżralitrófiš

Nafn_____________________________	

kennitala_________________________

Nafn foreldris_________________________________________________________

Gsm-foreldris _____________________	

heimasķmi________________________

Heimilisfang ______________________________________

Netfang foreldris ___________________________	

Er barniš ķ Vinafelli ?______________

Er barniš ķ Įlfheimum ? _______  

Er barniš ekki ķ lengdri višveru ? _______

Mį barniš labba sjįlft heim?___________________________

Mį birta myndir af barninu į heimsķšu kirkjunnar?________________________

Vinsamlega skiliš inn į fyrsta fundi.