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Inscriptions 2026-2027 groupe DECOUVERTE GAM 2
Mercredi 16h00-17h30
de 2017 à 2020
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NOM DE L'ENFANT
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Your answer
PRENOM DE L'ENFANT
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SEXE
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Féminin
Masculin
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DATE DE NAISSANCE
*
Date
NUMERO AVS
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NATIONALITE
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ADRESSE POSTALE
Numéro + Rue
*
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NPA + Ville
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COORDONNEES
NOM DU REPRESENTANT LEGAL
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TELEPHONE 1
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TELEPHONE 2
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Your answer
MAIL 1
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MAIL 2
Your answer
PROFESSION DES PARENTS
PERE
Your answer
MERE
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INFORMATIONS SANTE
Allergies, diabéte, informations importantes pour les entraîneurs
informations particulières
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Nom et numéro assurance complémentaire
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SIGNATURE
En cochant cette case ci dessous, je certifie l'exactitude des données ci dessus
SIGNATURE
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