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Fiche De Renseignementst

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

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1- ÉLÈVE

NOMPrénom(s)



  ! 



"##$

%&'' '()$*

2- RESPONSABLES LÉGAUX

MÈRE $*

#+,

# '

"



"-

%-.

/ 0

"

1&

1&2

1&-



3!



4-

3)&'&,$*

PÈRE$*

#

"

"-

%-.

/ 0

"

1&

1&2

1&-



3!



4-

................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

3)&'&,$*





. 25#(6-575%525"



3- AUTRE RESPONSABLE LÉGAL (PERSONNE PHYSIQUE OU MORALE)

$* 

'

"-

 -

!



1&

1&2



3)&'&,$*

Responsables légaux : Il est important de renseigner le document concernant les deux responsables légaux pour :



- La transmission des résultats scolaires (circulaire n

94-149 du 13/04/1994)



- Les élections des représentants des parents d'élèves : chaque parent est désormais électeur et éligible (note de

service n

2004-104 du 25/06/2004)



4- PERSONNES À APPELER EN CAS D'URGENCE ET/OU AUTORISÉES À PRENDRE L'ENFANT À

LA SORTIE

PERSONNE 1

#

 -

8 '

9 -



1&

1&2



PERSONNE 2

#

 -

 '

9 -



1&

1&2



5- ASSURANCE :



:2$*

*$*

'3

3



1-''2'

; ''9'&',<,&

7

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=>



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Completed 18 July 2020

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