Choose your son/daughter group: (required)
 3 to 4 years 5 to 7 years 8 to 10 years 11 to 14 years

Schedule: (required)
 From 9:00 to 14:00h. From 9:00 to 15:00h. From 9:00 to 18:00h.

Entrance date (e.g. 22/06/2018): (required)

Exit date (e.g. 03/08/2018): (required)

Name and Surname of your son/daughter: (required)

Born date of your son/daughter (e.g. 28/06/2008): (requerido)

Address: (required)

City: (required)

Zip code: (required)

Father Name and mobile contact: (optional)

Mother Name and mobile contact: (optional)

Mobile and 3rd contact mobile: (optional)

Father email: (optional)

Mother email: (optional)

Do you want the school transport ¡LIMITED PLACES! Service only available in Elche:
 no just single just return round trip

Upload photo card

HEALTH INFORMATION SHEET

Still a special regime? (Fill in only if applicable)

Is he/she allergic to something? (Fill in only if applicable)

Do you receive any medical treatment? (Fill in only if applicable)

Parent observations considered relevant to the care of children (fill in only if applicable)

Attach Photo of SIP and Private Medical Society card (in case of private insurance have also added)

PARENTAL AUTHORIZATION

Mr. / Ms.: (required)

I authorize my son / daughter: (required)

to participate in all scheduled activities in the course and to use your image for web, brochures, etc ...

Persons authorized to collect my son / daughter are: (required)

PAYMENT "Payment of the summer colony can be made in cash or if you wish you can also make a deposit:"

INCOME: IBAN ES94 2100 4627 1922 0011 3731• BANKING HOLDER: Sports & Events DGL S.L.
C/ Ribadeo ,13 · 03139 Valverde (ALICANTE)