DOSSIER D'INSCRIPTION - Courchevel
DOSSIER D'INSCRIPTION - Courchevel
DOSSIER D'INSCRIPTION - Courchevel
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<strong>DOSSIER</strong> D’INSCRIPTION<br />
STAGE DE DANSE HIP HOP<br />
« CAN’T STOP DANCING »<br />
Session 1<br />
Page 1/5<br />
LE STAGIAIRE<br />
NOM ………………………………………………………………………………..<br />
PRENOM ………………………………………………………………………….<br />
PHOTO<br />
SEXE Fille Garçon<br />
NE(E) LE ………………………………………….<br />
AGE …………….ans<br />
ADRESSE …………………………………………………………………………………………………………………………<br />
………………………………………………………………………………………………………………………………………….<br />
………………………………………………………………………………………………………………………………..........<br />
CODE POSTAL ……………………….. VILLE …………………………………….................................<br />
LE REPRESENTANT LEGAL<br />
Père Mère Tuteur légal<br />
NOM ………………………………………………………………. PRENOM ……………………………………………….<br />
ADRESSE …………………………………………………………………………………………………………………………<br />
………………………………………………………………………………………………………………………………………….<br />
CODE POSTAL …………………….. VILLE ……………………………………....................................<br />
TEL PORTABLE ………………………………………………. EMAIL ………………………………………………….<br />
TEL DOMICILE ………………………………………………. TEL PRO ……………………………………...........<br />
Autres personne à contacter en cas d’urgence :<br />
NOM ………………………………………………………………. PRENOM ……………………………………………….<br />
TEL PORT ……………………………… TEL DOM ……………………………TEL PRO ……………...…………….
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