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[]
[]
["（別紙５　病児保育事業）"]
["１．事業所に関する事項"]
[null,"施設の種類",null,null,null,null,null,"診療所",null,null,null,"病院",null,null,null,"認定こども園",null,null,null,null,null,"保育所"]
[null,null,null,null,null,null,null,"幼稚園",null,null,null,"小規模保育施設",null,null,null,null,null,null,"家庭的保育事業所"]
[null,null,null,null,null,null,null,"その他",null,"（　　　　      　　　　）"]
[null,"事業の種別",null,null,null,null,null,"病児対応型",null,null,null,null,null,"病後児対応型",null,null,null,null,null,"体調不良児対応型"]
[null,null,null,null,null,null,null,"非施設型（訪問型）"]
[null,"名称"]
[null,"所在地",null,null,null,"〒　　　－　　　　"]
[]
[null,null,null,null,null,"TEL：",null,"　　－　　　－　　　　",null,null,null,null,null,null,"ﾒｰﾙｱﾄﾞﾚｽ："]
[null,"事業の\n管理者",null,null,null,"職名",null,null,null,null,null,null,null,"フリガナ"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名"]
[null,null,null,null,null,"住所",null,null,null,null,null,null,null,null,null,"生年\n月日",null,"昭和\n平成",null,null,null,"年",null,"月",null,"日"]
[]
["２．運営に関する事項"]
["　（１）開設時間"]
[null,"曜日",null,null,null,null,null,null,null,"開設時間※"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"～"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"～"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"～"]
[null,"※２４時間標記で記入してください。"]
[]
["　（２）利用定員"]
[null,"利用定員"]
[]
["　（３）対象年齢"]
[null,null,"０歳児",null,null,null,"１歳児",null,null,null,"２歳児",null,null,null,"３歳児",null,null,null,"４歳児",null,null,null,"５歳児"]
[null,null,"就学児（小学　　年生まで）"]
[]
["　（４）利用料金"]
[null,"　　　料金種別\n\n料金の内容　　　　　　　　",null,null,null,null,null,null,"日額",null,null,null,null,null,"半日",null,null,null,null,null,"１時間当たり"]
[null,null,null,null,null,null,null,null,"市内",null,null,"市外",null,null,"市内",null,null,"市外",null,null,"市内",null,null,"市外"]
[null,"保育料"]
[null,"その他",null,null,"（　　　",null,null,"　）"]
[null,"その他",null,null,"（　　　",null,null,"　）"]
[null,"その他",null,null,"（　　　",null,null,"　）"]
[]
[null,"食事の提供の有無",null,"有","(有の場合は、以下も記入してください。）"]
[null,null,null,"食事代",null,"１食当たり",null,null,null,0,null,null,null,null,"月当たり",null,null,0]
[null,null,null,null,null,"その他",null,"（　　　　　）",null,null,null,null,null,0]
[null,null,null,"・上記の食事代は、パンフレット等に記載している保育料に含んでいますか"]
[null,null,null,null,"□","はい",null,"□","いいえ"]
[null,null,null,"無"]
[]
[]
[]
[]
[]
["　（５）職員の定数及び職務の内容"]
[null,"職員数",null,null,null,null,null,null,null,null,null,"常勤",null,null,"非常勤",null,null,"合計"]
[]
[null,"資格別の内訳","保育士"]
[null,null,"幼稚園教諭"]
[null,null,"保育教諭"]
[null,null,"看護師"]
[null,null,"准看護師"]
[null,null,"保健師"]
[null,null,"助産師"]
[null,null,"その他（　　　　　　　　　　　　　　）"]
[null,null,"その他（　　　　　　　　　　　　　　）"]
[]
["　（６）協力機関・指導医の状況"]
[null,"協力機関","設定の有無",null,null,null,"有",null,null,"無","無の場合は、その理由",null,null,null,null,null,null,"（　　　　）"]
[null,null,"名称"]
[null,null,"所在地",null,null,"〒　　　－　　　　"]
[]
[null,null,null,null,null,"TEL：",null,"　　－　　　－　　　　",null,null,null,null,null,null,"ﾒｰﾙｱﾄﾞﾚｽ："]
[null,null,"協力内容"]
[null,"指導医","設定の有無",null,null,null,"有",null,null,"無","無の場合は、その理由",null,null,null,null,null,null,"（　　　　）"]
[null,null,"名称"]
[null,null,"所在地",null,null,"〒　　　－　　　　"]
[]
[null,null,null,null,null,"TEL：",null,"　　－　　　－　　　　",null,null,null,null,null,null,"ﾒｰﾙｱﾄﾞﾚｽ："]
[null,null,"指導内容"]
[]
["３．設備に関する事項"]
["　（１）保育室等の面積"]
[null,"保育室等の種類",null,null,null,null,"保育室",null,null,null,"観察室",null,null,null,"調理室\n（専用・兼用）",null,null,null,"その他\n（　　　　　）",null,null,null,"合計"]
[null,"面積"]
[null,"乳幼児一人当たり面積"]
[]
[]
[]
[]
[]
[]
["（添付書類）"]
[null,"１　児童福祉法第３４条の１８の規定により届け出た病児保育事業開始届及び変更届の写し\n　　（上記記載事項の最新の状況を確認するため必要なものの抜粋で差し支えない）"]
[null,"２　料金表及び利用案内・パンフレット"]
[null,"３　施設の図面（保育室等の配置がわかるもの）"]