Camp de jour

Child's first name *

Specify the nation *

Child's last name *

Specify other nationality *

Gender *

Male Female ungendered

languages spoken *

French English Algonquin/anicinabe Cree

Other *

Age *

School year in September 2024 *

Date of birth (DD/MM/YYYY) *

Teacher's name *

Prénom

Nom

Registration to *

After school Pedagogical Days

Name of first parent or guardian *

Prénom

Nom

Name of second parent or guardian *

Prénom

Nom

Address *

Ligne 1

Ligne 2

Ville

État

Code postal

Pays

Phone number *

Cell/office *

Email *

Address *

Ligne 1

Ligne 2

Ville

État

Code postal

Pays

Phone number *

Cell/office *

Email *

Emergency contact *

Prénom

Nom

Emergency contact number *

Relationship with the child *

Emergency contact *

Prénom

Nom

Emergency contact number *

Relationship with the child *

Is the child allowed to leave alone? *

Yes No

Does your child have any allergies? *

Does your child suffer from asthma? *

Yes No

Does your child suffer from diabetes? *

Yes No

Is your child taking any medication? *

Yes No

List of drug(s) or special recommendations *

Special condition to mention? *

Autism behavioral disorder oppositional defecation disorder

In order to offer your child personalized support, please specify his/her challenges/needs. *

I authorize the VDIFC to use photos of me and my child for the promotion of activities. *

Yes No

I authorize my child to use the VDIFC and Taxi 24 transportation services during activities organized by the After school or PD Days. *

Yes No

The Val-d'Or Indigenous Friendship Centre cannot be held responsible for loss, theft or accidents. Having read all the above information, I authorize my child to attend the After school and PD days organized by the VDIFC. *

I accept

Action jeunesse

Registration form

Identification of parents or guardians

Authorizations

Action jeunesse

Registration form

Identification of parents or guardians​

Authorizations​

Identification of parents or guardians

Authorizations