REGISTRATION FORM - Qilineduc

IDENTITY *

Prénom

Nom

First name / Family name

LEGAL GUARDIAN

Prénom

Nom

First name / Family name *Necessary for under 18

LEGAL GUARDIAN PHONE NUMBER :

LEGAL GUARDIAN EMAIL : *

DATE OF BIRTH *

EMAIL *

PHONE NUMBER *

EMERGENCY NUMBER

ADDRESS *

Adresse 1

Ville

État / Province / Région

Code postal

Pays

APPRECIATED SPORTS

HOBBIES

Additional information you want to let Qilin know

AVAILABILITY

Options

COURSE *

FRENCH AND HORSE RIDING
OTHER

Arrival date *

(Sunday)

Departure date *

(Saturday)

ACCOMODATION

YES
NO

TYPE OF ACCOMODATION

EXCPECTED DATES

INSURANCE *

Check this box if you subscribe to Personal Accident Insurance (Federal License) through Qilin. This insurance does not include repatriation
I already have insurance

Insurance company name

address

Insurance contract number

AUTORISATIONS

I agree that:

Information, only on Qilin's activities, is sent to me occasionally by e-mail *

YES
NO

Photos of my person, individual and collective, are taken and used by Qilin on social media, promotional materials: *

YES
NO

Signature *

REGISTRATION FORM 2022-2023 “TO BE COMPLETED & SUBMITTED ONLINE “

AVAILABILITY

AUTORISATIONS

I agree that: