Régional grandes- Semaine 5 du 21 au 25 juillet 2025

Participant's first name :

Participant's last name :

Participant's gender :

Participant's date of birth :

Full name of person to contact in case of emergency (if parents cannot be reached) :

Telephone of the person to contact in case of emergency (if the parents are not reached) :

I authorize the transport of this child by the persons in charge assigned to the transport :

This child needs a car seat for transportation :

Health Insurance number :

Health Insurance Card Expiry :

Particular health conditions of the participant :

Registration