CHILD TO BE REGISTERED : Fill in one form per child (if necessery please make extra photocopies)A
SURNAME :.
.
.
……………………………………………………………………………………………….
.
…….
.
.
First name :….
.
.
…………………………………………………………….
……………………………………….
Date of birth : …….
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/…….
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CHILD TO BE REGISTERED : Fill in one form per child (if necessery please make extra photocopies)A
SURNAME :.
.
.
……………………………………………………………………………………………….
.
…….
.
.
First name :….
.
.
…………………………………………………………….
……………………………………….
Date of birth : …….
.
/…….
.
/…….
.
Place of birth (town/country) :…….
.
.
………………………….
.
.
….
…………………………………………………
Sex :
Girl Boy
PRICING : FULL PRICE – or MSA* Do you have a price reduction card from the child benefit office CAF/MSA* : A* B* (* if so, please provide the document)
YOU (person legally responsable for the child): YOUR PARTNER :
SURNAME : ……………………………………………….
……………………………………………….
First name : ……………………………………………….
……………………………………………….
Address : ……………………………………………….
……………………………………………….
Post code : ……………………………………………….
……………………………………………….
Town : ……………………………………………….
……………………………………………….
Social Security number : ……………………………………………….
……………………………………………….
Insurance policy number : ……………………………………………….
……………………………………………….
N°……….
…………………………………….
N°……….
………
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