Inscriptions

info

Atelier / projet

Child/participant

child__multiplier_rows

Child/participant [#1]

Family name

First name

Date of birth

Gender

Représentants légaux

Full name (1)

Phone (1)

Full name (2)

Phone (2)

Street and number

Postal code

Location

Country

Child’s/participant’s health and accident insurance

Remarks concerning the child’s/participant’s health (allergies, medication, diet, etc.)

Tetanus vaccination

If yes, date

Person to contact in case of emergency (1)

Person to contact in case of emergency (2)

Payer plus tard sur facture

I confirm that I have read and accepted the registration conditions. I also confirm that my child/children are covered by civil liability insurance. I agree that GODZILLAB may take photo-graphs of my child/children for the purposes of documenting activities. If I do not agree to this, I must give my consent in writing and with a valid signature. I must send this document to the association before the first day of the workshop in which my child/children are taking part.