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Inscription périscolaire annuelle Patronage l'Angevine
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Fiche de renseignements
Prénom de la mère :
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Nom de la mère :
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Tel de la mère :
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Email de la mère :
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Prénom du père :
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Nom du père :
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Tel du père :
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Email du père :
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Adresse postale 1
Numéro et nom de la rue :
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Code Postal :
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Ville :
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Adresse postale 2
Numéro et nom de la rue :
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Code postal :
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Ville :
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Coefficient familial :
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Avez-vous déjà payé la cotisation 2025 à l'Association Les Talents d'Eloi ?
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Sans titre
Souhaitez-vous recevoir la newsletter trimestrielle de l'association ?
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Comment avez-vous connu l'offre périscolaire du patronage ?
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Combien d'enfant(s) souhaitez-vous inscrire au patronage ?
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Renseignements enfant
Nom :
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Prénom :
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Date de naissance :
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Âge :
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Etablissement scolaire fréquenté :
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Classe :
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Inscription au patronage
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Commentaires éventuels :
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Renseignements enfants
Enfant 1 :
Nom :
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Prénom :
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Date de naissance :
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Âge :
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Etablissement scolaire fréquenté :
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Inscription au patronage
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Enfant 2
Nom :
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Prénom :
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Date de naissance :
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Âge :
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Etablissement scolaire fréquenté :
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Classe :
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Inscription au patronage
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Commentaires éventuels :
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Renseignements enfants
Enfant 1 :
Nom :
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Prénom :
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Date de naissance :
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Âge :
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Etablissement scolaire fréquenté :
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Classe :
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Inscription au patronage
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Commentaires éventuels :
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Enfant 2
Nom :
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Prénom :
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Date de naissance :
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Âge :
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Inscription au patronage
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Enfant 3
Nom :
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Prénom :
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Date de naissance :
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Âge :
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Inscription au patronage
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Commentaires éventuels :
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Renseignements enfants
Enfant 1 :
Nom :
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Prénom :
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Date de naissance :
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Âge :
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Etablissement scolaire fréquenté :
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Classe :
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Inscription au patronage
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Commentaires éventuels :
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Enfant 2
Nom :
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Prénom :
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Date de naissance :
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Âge :
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Etablissement scolaire fréquenté :
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Classe :
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Inscription au patronage
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Commentaires éventuels :
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Enfant 3 :
Nom :
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Prénom :
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Date de naissance :
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Âge :
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Classe :
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Inscription au patronage
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Enfant 4
Nom :
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Prénom :
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Date de naissance :
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Âge :
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Etablissement scolaire fréquenté :
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Classe :
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Inscription au patronage
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Commentaires éventuels :
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Renseignements enfants
Enfant 1 :
Nom :
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Prénom :
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Date de naissance :
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Âge :
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Etablissement scolaire fréquenté :
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Classe :
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Inscription au patronage
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Commentaires éventuels :
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Enfant 2
Nom :
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Prénom :
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Date de naissance :
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Âge :
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Etablissement scolaire fréquenté :
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Classe :
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Inscription au patronage
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Commentaires éventuels :
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Enfant 3
Nom :
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Prénom :
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Date de naissance :
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Âge :
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Etablissement scolaire fréquenté :
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Classe :
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Inscription au patronage
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Commentaires éventuels :
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Enfant 4 :
Nom :
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Prénom :
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Date de naissance :
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Âge :
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Etablissement scolaire fréquenté :
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Classe :
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Inscription au patronage
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Enfant 5
Nom :
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Prénom :
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Date de naissance :
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Âge :
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Etablissement scolaire fréquenté :
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Classe :
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Inscription au patronage
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Validation de vos données
Pour plus d'information, et notamment pour exercer vos droits d'accès, rectification, ou suppression, merci d'envoyer un e-mail à contact@lestalentsdeloi.fr
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