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["栃木県子ども総合科学館　団体利用申込書",null,null,null,null,"申込み日：令和　　　(20　　　　)年　　 月　 　日(　　　)"]
["利  用  日","令和　　　（20　　　）年　　　　月　　　　日（　　　）",null,null,null,null,null,"団体担当者名"]
["ふ り が な"]
["団  体  名"]
["電 話 番 号",null,null,null,null,"学校の場合は　　 　    学年を記入",null," 　 年少 ･　年中 ･ 年長      　 　　　　　年生"]
["所 在 地",null,null,null,null,"都　・ 道\n府　・ 県",null,null,null,"市  ・ 町 ・ 村"]
["滞 在 時 間","到着時刻","：",null,null,"～","出発時刻","："]
["当日の天候で目的地に変更\nがあるか該当する方に○",null,"天候に関わりなく来館",null,null,null,"雨天のみ来館",null,null,"晴天のみ来館"]
["ご利用希望施設に○\n※プラネタリウムの時間等は\n科学館で記入します。",null,"展示場",null,null,"屋外遊具",null,0,"乗り物広場"]
[null,null,"プラネタリウム",null,"※希望時間",null,null,"※希望番組",null,null,"15分前説明\n未・済"]
["《入館予定人数》"]
["　　　ⅰ　有料入館者"]
[null,"小人",null,"名","大人",null,"名",null,"入館者合計"]
["　　　　　　　　","（４才以上中学生以下）",null,null,"（高校生以上）",null,null,null,{"$f":"+C12+F12+C17+F17","v":0}]
[null,null,null,null,null,null,null,null,null,null,"名"]
[]
["　　　ⅱ　無料入館者"]
[null,"引率",null,"名","幼児",null,"名"]
[null,"（ボランティア・教育実習生などは対象外）",null,null,null,"（3才以下）"]
[]
["バスの台数等","大型　　　　台　　　　　マイクロ　　　台　　　　　自家用車　　　台　　　　　その他(　　　　　　　　）"]
[" 　昼食 ・ ショップ利用の有無","【昼　食】","お弁当持参 　 ・　  利用なし　",null,null,null,"【ショップ】","有　　・　無"]
["下見利用希望日時","【希望日】","令和　　　（20　　　）年　　　月　　　日(　　)　",null,null,null,"【時　間】","：",null,"【人　数】","人"]
["備　　考"]
[]
["　【旅行会社記入欄】"]
["会 社 名",null,null,null,null,"担当者名"]
["電話番号",null,null,null,null,"FAX番号"]
["　　当館から連絡する場合の窓口\n　　＊該当する方にレ点",null,"□","旅行会社",null,"□","団体の担当者"]
[]
["　【科学館記入欄】","□ 検温",null,null,"□  免除申請書お渡し済  ",null,null,null,null,"受付者"]
[null,"□ マスク着用",null,null,"□  免除申請書受取り日（ 　　/　　 ）  　"]
[null,"□ ショップ少人数利用"]
[]
[null,"栃木県子ども総合科学館",null,null,null,null,"　〒321-0151栃木県宇都宮市西川田町567"]
[null,null,null,null,null,null,"　TEL:028-659-5555 / FAX:028-659-5353"]