Subscription Form swimming 2017-2018
to be sent from 24th June from 9:00 am (not before)
Please fill in this form to subscribe your child to a swimming activity, (a form for every child) and send it (as an email attachment) to the coordinator
You will receive an e-mail in reply which will include:
Ø the amount to be paid as fees,
Ø the bank account number to be paid,
Ø the code to be quoted in the communication text-box.
Reminder : the subscription will not be valid until payment has been made after you receive the confirmation email. Please do not make any payments before you receive confirmation of the subscription.
Attention - new rules:· All subscription requests are accompanied by an administrative charge of 25€. This charge will be included in the fees but it will not be reimbursed if the subscription is cancelled.
· 10 € will be changed for any changes in courses for personal convenience
· All subscriptions made before 1st September must be paid before that date. A default of payment on 1st September will lead to an automatic cancellation of the subscription.
·
Césame : Mme Récalde Dominique
Phone : 02 375 31 35 Fax : 02 375 33 25
email :
Coordinator : Serge Englebert
email :
TO BE COMPLETED IN CAPITAL LETTERS PLEASE
For parents :
Don’t forget to communicate your new mail adress if it changes during the year
Name :Street : / nr°
City : / postcode:
Private phone : / Gsm (Mrs):
Gsm (Mr):
Email : (only one adress)
Phone office: / Mr : / Mrs :
For kids :
Name : / Surname :School : / Uccle – Woluwé – Ixelles – Laeken / Class :
(2017-2018) / Mat / Prim / Sec / Section :
Activity / 1x/ week / 2 x/ week / 3 x/ week / 4 x/ week
Code / N° / N° / N° / N° / Indicated the 4 numbers of the activity reported on the programme. Do not indicate a second choice.
For children who were in level 1, indicate the trainer’s name of the previous year : …………………….
I hereby declare that I have read and accepted the settlement and conditions of swimming activities
Signature of a parent