JOIN THE CHILD

Choose your situation * : Registration renewalNew registration

Child's Name * :   Child's first name * :
Child's gender * : MaleFeminine
Date of birth of the child * :
belt color * : —Veuillez choisir une option—BlancheBlanche 1 edgingBlanche 2 edgingWhite/YellowJauneYellow orangeOrangeOrange/GreenVerteGreen/BlueBlueBlue/BrownMarron  

the legal representative Information :
Name * :    First name * :

Email (Father):    Phone (Father) :
Email (Mother) :    Phone (Mother) :

Address * :  
Code postal * :    City * :

Doctor * :    Phone * :

 Thanks to this form, I wish to take a license Judo Judo Club Lansargues with the French Judo Federation and participate in trainings sessions and meetings organized in the Judo Club Lansargues. I also agree with the insurance Bodily Accidents proposed by the FFDJA not mandatory, I acknowledge having been informed of the risks to the practice of Judo and D. A. that could endanger my physical integrity.

 I authorize sports instructors of Judo Club Lansargues, as part of activities, to take all emergency measures about me, in case of emergency, accident or serious illness, so I receive the necessary care. I note that the facilitator ensures only responsibility during activities.

 Insofar images of myself would be taken during sports, Authorize the Judo CLub Lansargues to use freely gratis (without payment) for carrying out various information and communication media.

* By checking this box I certify be in possession of a valid medical certificate of non-cons-indication to the sport of judo, including competition.

If there are several children in the same family register (discount on the federation license), thank you note their name and date of birth in the part "comment". In this case please choose payment by check

Choice of payment method * : —Veuillez choisir une option—CheckBank card

Download the d & rsquo; registration in case of problem & rsquo; access : Registration

Copy d & rsquo; a medical certificate : Medical certificate