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Inscriptions 2019-2020 DECOUVERTE GAC
DECOUVERTE GAC MERCREDI 14H00-15H30
NOM DE L'ENFANT *
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PRENOM DE L'ENFANT *
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DATE DE NAISSANCE *
MM
/
DD
/
YYYY
NATIONALITE *
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ADRESSE
NPA *
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COMMUNE *
Your answer
RUE *
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NOM DU REPRESENTANT LEGAL *
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TELEPHONE 1 *
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TELEPHONE 2 *
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MAIL 1 *
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MAIL 2
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PROFESSION DES PARENTS
PERE *
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MERE *
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SIGNATURE
En cochant cette case ci dessous, je certifie l'exactitude des données ci dessus
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