Le Patro
Fort-Coulonge/Mansfield

Fort-Coulonge/Mansfield, for all our youths!!

[ Français | Home | Mission (French) | Objectives (French) | Pastoral Resources | Activities | Rentals (French) | Our team (French) | How to find us (French) | Installations (French) | Contact-us | How to help? | Pictures | Links (French) ]

Registration



Daycare service :

Choice of date:

June 30 th to July 4 th:
July 7 th to July 11 th :
July 14 to July 18 :
July 21 st to July 25 :
July 28 to August 1 st :
August 4 to August 8 :
August 11 to August 15 :

Child's name:
Child's first name:
Age : # Medical insurance number:
Expiration date:
Date of birth:
Adress :
City: include postal code
Phone : include regional code
# Emergency phone number: include regional code
E-mail:

Additional notes:

In case of emergency, if I can't be reached, I autorise the Patro staff to take the necessary actions to assure my child's health:
Autorisation :
Parent's name:

*You have to click the send button to send the form and give authorisation to the Patro staff to take necessary actions for your childs health if you can't be reached. Don't forget your paiement.

Before you send the form make sure that all fields are filled out. Click send


Send your payement to:
Patro de Fort-Coulonge/Mansfield
209 ch. De la Passe
Masfield (Québec)
J0X-1V0
# Phone: (819) 683-3347 # Fax: (819) 683-3546

Dernière mise à jour : 2008-05-15

-> Home
-> Français
-> Mission (French)
-> Objectives (French)
-> Pastoral Resources
-> Activities

-> Our team (French)
-> How to find us (French)
-> Installations (French)
-> Contact-us
-> How to help?
-> Pictures
-> Links (French)





Visitors since mai 2008: 9957

[ Français | Home | Mission (French) | Objectives (French) | Pastoral Resources | Activities | Rentals (French) | Our team (French) | How to find us (French) | Installations (French) | Contact-us | How to help? | Pictures | Links (French) ]