OFFICIAL DISCHARGE FOR UNDER 16

OFFICIAL DISCHARGE
FOR UNDER 16-YEAR OLD STUDENT
Mrs _______________________
Mr _______________________
You have applied for your teenage son/daughter __________________________________________
who is at least 16 years old, to attend one of our group classes.
L’Alliance française de Bruxelles-Europe authorizes this registration provided under three conditions:

Registration will become official upon reception of this form, duly completed and signed by the teenager
and his/her parent/legal guardian.

In case of an integration issue or any problem related to the class and on the teacher’s advice, we
reserve the right to cancel this registration. We will then refund the prorated balance of the fees
received.

The standard class in which the teen ager is registered is targeted for adults, in an environment
designed for adults. We therefore waive all responsibility and liability other than that applying to adult
students.
By signing I agree with the above-mentioned conditions.
Date:
________________
Date:
(signature of the student)
________________
(signature of the parent/legal guardian)
PEOPLE TO CONTACT IN CASE OF AN EMERGENCY
Last name: ________________________________
Last name: ________________________________
First name: ________________________________
First name: ________________________________
Legal status: _______________________________
Legal status: _______________________________
Belgian cell phone number:
Belgian cell phone number:
_________________________________________
_________________________________________
Contact email:
Contact email:
_________________________________________
_________________________________________
Form given on
________________
Form and copy of the student’s identity documents returned on
Registration processed on
________________
________________ by ________________
Alliance française de Bruxelles-Europe, Centre Européen de Langue Française, asbl
Avenue des Arts 46 - B-1000 BRUXELLES - Belgium
Phone: +32 (0) 2 788 21 60 - [email protected] - www.alliancefr.be
Fiscal identification number: 0408099685