D./Dña.

_______________________________________________ con DNI __________

como padre/madre/ alumno/a _____________________________________________
matriculado en el IES Manuel de Falla, en el grupo ___________,

EXPONE:
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por lo cual,
SOLICITA:
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En Coslada, a _______ de _________________________ de _______________

FIRMA:
Fdo.: ______________________________________________________

A la atención de _________________________________________________________