Your child's name *

First Name

Last Name

Do you need to take medical or dietary precautions for your child *

Yes

No

Parent 1 name *

First Name

Last Name

Correspondence *

English

Français

Parent 2 name

First Name

Last Name

Correspondence

English

Français

Both parents

If the parents are separated/divorced, who has legal parental authority?

Parent 1

Parent 2

If the parents are separated/divorced, with whom does the child reside?

Parent 1

Parent 2

If the parents are separated/divorced, who receives the correspondence?

Parent 1

Parent 2

Monday

Whole day (8:00 – 16:00)

After school 1 (16:00 – 17:00)

After school 2 (17:00 – 18:00)

Tuesday

Whole day (8:00 – 16:00)

After school 1 (16:00 – 17:00)

After school 2 (17:00 – 18:00)

Wednesday

Whole day (8:00 – 16:00)

After school 1 (16:00 – 17:00)

After school 2 (17:00 – 18:00)

Thursday

Whole day (8:00 – 16:00)

After school 1 (16:00 – 17:00)

After school 2 (17:00 – 18:00)

Friday

Whole day (8:00 – 16:00)

After school 1 (16:00 – 17:00)

After school 2 (17:00 – 18:00)

I would like my child to be taken care of during Vaud school holidays *

Yes

No

Billing period *

Annual (2% discount)

Quarterly

Monthly

Invoice in the name of *

Parent 1

Parent 2

Other

If other please specify

First Name

Last Name

I authorise my child’s photos to be used in communication/marketing *

Yes

No

I authorise the educators to administer medication to my child in the event of an emergency: Disinfectant, arnica, healing cream, bandage. *

Yes

No

Parent 1 *

First Name

Last Name

Parent 2 *

First Name

Last Name

By sending this form, the parents and/or the persons civilly and/or financially responsible declare to have read, understood and accepted the general and annexed financial conditions. They also declare that all the information mentioned is correct. (Terms and Conditions) *