For information, call Frédéric Pilote : 677-4000 extension 7563

Registration formGolf le Ricochet - Sunday, August 3rd

Limit date subscription & payment Tuesday, July 15 th(non reimbursable) Return registration form and payment:

Administration office Rec. Center and Game Room Community center

General information

Full name : _____

Address : _____ Town : __________________________

C.P : Postal code : Phone : _________

Age : Date of birth : _ _ / _ / _ _ (day/ month /years

Health insurance number : ________ Exp Date :_____________________

Parent : House : Work : ___Parent : _______________ House : Work : ___

Person to contact in case of emergency : _____________________

Médical information : ___

To report to the Administration office Rec Center and Game Room Community center: Tuesday July 8th

Dates Hours Activity Age Package $

XSunday

August 3rd8:00am to 1:00pm Golf le Ricochet 12-17 y/o Including transportation and introduction golf

10 $

Votre Total 10 $

I authorize my child to participate in the following activity : Golf Le RicochetAnd by the same token, I release: See attached document for signing

This information contained on this sheet are confidentialThe organization of the Personal Support Program is committed to respect

confidentialityFor information, contact Fred Pilote, recreational monitor at 677-

4000extension 7563.

For information, call Frédéric Pilote : 677-4000 extension 7563

Registration formTrou de la fée Wednesday, August 13th

Limit date subscription & payment Tuesday, August 5th(non reimbursable) Return registration form and payment:

Administration office Rec. Center and Game Room Community center

General information

Full name : _____

Address : _____ Town : __________________________

C.P : Postal code : Phone : _________

Age : Date of birth : _ _ / _ / _ _ (day/ month /years

Health insurance number : ________ Exp Date :_____________________

Parent : House : Work : ___Parent : _______________ House : Work : ___

Person to contact in case of emergency : _____________________

Médical information : ___

To report to the Administration office Rec Center and Game Room Community center: Tuesday July 8th

Dates Hours Activity Age Package $

XWednesday August 13th

7:30am to 4:30pm Trou de la fée 12-17 y/o Including transportation and visit15 $

Votre Total 15 $

I authorize my child to participate in the following activity : Trou de la féeAnd by the same token, I release: See attached document for signing

This information contained on this sheet are confidentialThe organization of the Personal Support Program is committed to respect

confidentialityFor information, contact Fred Pilote, recreational monitor at 677-

4000extension 7563.