Accueil périscolaire ODEL de Pierrefeu du Var Année scolaire 2017-2018 RENSEIGNEMENTS NOM & Prénom du responsable légal à prévenir en priorité : Tél portable & travail :

Mail :

NOM & Prénom du responsable légal à prévenir : Tél portable & travail :

Mail : SOUHAITS DE RESERVATION DE SEPTEMBRE

Nom & Prénom du 1er enfant :

LUN

MAR

JEU

VEN

LUN

MAR

JEU

VEN

4/9

5/9

7/9

8/9

11/9

12/9

14/9

15/9

M-S

M-S

M-S

M-S

M-S

M-S

M-S

M-S

LUN

MAR

JEU

VEN

LUN

MAR

JEU

VEN

18/9

19/9

21/9

22/9

25/9

26/9

28/9

29/9

M-S

M-S

M-S

M-S

M-S

M-S

M-S

M-S

LUN

MAR

JEU

VEN

LUN

MAR

JEU

VEN

2/10

3/10

5/10

6/10

9/10

10/10

12/10

13/10

M-S

M-S

M-S

M-S

M-S

M-S

M-S

M-S

Nom & Prénom du 2ème enfant :

LUN

MAR

JEU

VEN

LUN

MAR

JEU

VEN

4/9

5/9

7/9

8/9

11/9

12/9

14/9

15/9

M-S

M-S

M-S

M-S

M-S

M-S

M-S

M-S

LUN

MAR

JEU

VEN

LUN

MAR

JEU

VEN

18/9

19/9

21/9

22/9

25/9

26/9

28/9

29/9

M-S

M-S

M-S

M-S

M-S

M-S

M-S

M-S

LUN

MAR

JEU

VEN

LUN

MAR

JEU

VEN

2/10

3/10

5/10

6/10

9/10

10/10

12/10

13/10

M-S

M-S

M-S

M-S

M-S

M-S

M-S

M-S

Entourez les mentions utiles : M = Périscolaire matin ; S = Périscolaire soir ; Fiche d'inscription à rendre au moins 5 jours ouvrés avant la première date d'inscription souhaitée La participation financière familiale du périscolaire est facturée en début du mois suivant et doit être régler à la mairie

Je soussigné(e) responsable légal de l’enfant déclare avoir pris connaissance des modalités d’inscription et de règlement.

Date :

Signature :

04 PERI SEPT.pdf

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