Enrolment application

Family name and child’s first name *

Date de birth (day/month/year) *

Due date (day/month/year)

Family name and first name of the person making the enquiry *

Phone *

Email *

Enrolment from month (month/year) *

Option required *

99, rue Prince Henri
L-7230 Helmsange

Tél.: (+352) 27 84 90 71

Email: info@cannelletcaramel.lu

www.cannelletcaramel.lu