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[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Association Sportive Noiseraie Champy"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Gymnase de la Butte Verte "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"5 Boulevard du Champy-Richardets"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"93160 Noisy Le Grand"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Contact : Raphael VESSIER"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Tel. : 06 87 95 09 42"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Courriel : ",null,null,null,null,"inscription@grimpeanoisy.fr"]
[]
[]
[null,"Bulletin d'Adhésion \"Adolescent\""]
[]
[]
[]
[null,null,null,null,null,null,null,null,"Adhérents nés de 2000 à 2006 (années comprises)"]
[]
[null,null,null,null,null,null,null,null,null,"Les cases",null,null,null,null,null,"  ci-dessous indiquent une option. Elles sont à cocher selon l'option choisie."]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Tarif des adhésions :",null,null,null,null,null,null,null,null,null,null,85,null,null,"(*)"]
[]
[null,"Partie relative à l'adolescent ",null,null,null,null,null,null,null,null,null,null,null,null,null,"(A remplir en majuscules)"]
[]
[null,"NOM :"]
[]
[]
[null,"Pénom :"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(*) Chèque à libeller à l'ordre de AS Noiseraie Champy",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[]
[null,"Date de naissance : "]
[]
[null,"Adresse :"]
[]
[]
[]
[null,"Code postal :",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ville : "]
[]
[null,"Téléphone portable :"]
[]
[null,"En signant ce bulletin d'adhésion, en tant que",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Autorisation parentale :"]
[]
[null,"1°) je reconnais :"]
[null,"- être informé qu'aucun remboursement ne sera effectué, "]
[null,"- avoir reçu une notice d'assurance et en avoir pris connaissance avant d'adhérer.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Tuteur légal à préciser :"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NOM : "]
[null,"- avoir reçu une notice relative à la fourniture, selon le cas,",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prénom :"]
[null,null,"d'un certificat médical de moins d'un an ou d'une attestation et",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Adresse :"]
[null,null,"après avoir répondu au questionnaire santé, fournir en conséquence :"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Code postal :",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ville : "]
[null,"2°) j’autorise l’ASNC à prendre, détenir et diffuser mon image ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Téléphone domicile :"]
[null,"(ou l’image de mon enfant si l’adhérent est mineur) sous ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Téléphone portable :"]
[null,"quelque forme de support que ce soit. Les images sont ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Adresse e-Mail :"]
[null,"acquises définitivement au profit de l’ASNC quelle que soit la ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"J'autorise mon enfant :",null,null,null,null,null,null,null,null,null,null,"(Indiquer  prénom)"]
[null,"période de leur utilisation et sans aucun paiement.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(F30=\"\",\"\",F30)","v":""}]
[null,"3°) je m'engage à ce que mon enfant : ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"- à adhérer à l'AS Noiseraie Champy, "]
[null,"- respecte le règlement intérieur de l'association et ceux des installations sportives utilisées",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"- à être transporté en voiture particulière ou en car, dans"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"le cadre des déplacements organisés par le club."]
[null,"4°) je souhaite recevoir la Newsletter de l'association à l'adresse",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"- à recevoir personnellement les informations du club :"]
[null,"e-Mail suivante :",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," - à son adresse e-Mail ci-dessous :"]
[null,"5°) je joins à ce bulletin (**) :"]
[null,null,null,"- Le présent bulletin d'adhésion dûment complété puis imprimé, daté et signé (une pré-inscription est vivement conseillée en renvoyant par mail ce bulletin en format Excel à inscription@grimpeanoisy.fr)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"J'autorise les responsables du club ou responsable de la sortie à faire dispenser les soins nécessaires et utiles en cas d'urgence sur mon enfant."]
[]
[null,null,null,"- deux photos d'identité au format 35 mm X 45 mm"]
[null,null,null,"- deux enveloppes timbrées à mon adresse domiciliaire"]
[null,null,null,"- le chèque de cotisation.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date et Signature du représentant légal :"]
[null,null,null,"- Le certificat médical ou l'attestation"]
[null,"Date et Signature du parent ou du tuteur"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," (**) Seul les dossiers complets seront pris en compte"]

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