La Reserve

Participant's Identity
Name:	*
First Name:
Date of birth:
Place of birth:
Nationality:
Sex:	Boy		Girl
Registration
Session:	1		2		3		4
From:				To:
Number of sessions:
Further Information
Name of Father:					Professional:
Name of Mother:
Complete Address:
Tel. 1:				Tel. 2:					Fax:
Cell:				E-mail:
Name & address of the legal guardian:
Tel. 1:				Fax:					Cell:
Health Form
Treatments to be observed meticulously:
Blood group:
Allergies:
Special Remarks:
Name of pediatrician:					Tel.:
Cell:
By their signature, parents certify that their child is in perfect health.
By his signature, the parent or guardian accepts the general conditions of this contract.
Name:
City:				Date:				Signature:

Nourriture et boissons

Admission Form

Conditions générales