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unknown - inscription mineurs FS en Document publié le Jeudi 1 janvier 2026 par la commune de Saint-Yrieix-la-Perche. Lien du pdf (unknown - inscription mineurs FS en)Thèmes du document : Sport, Médias, Famille, p. 1

REGISTRATION FORM FOR A MINOR

SPORTS PROGRAMME

Date of birth Sex M F

Address

Email address

Telephone number

Parent or legal guardian

First and last name

Child

I, the undersigned, (first and last name of the parent or legal guardian),

authorize my child (child's first and last name)

certify that my child:

have seen and read the charter of sports activities ‘Serene holidays with Sports Programme’

First and last name

REGISTRATION FORM

PARENTAL AUTHORISATION

to take part in the physical activities offered by ‘Sports Programme’,

to travel alone between the event venue and their home,

is in good physical condition and has no medical conditions that would prevent me from taking part in the physical and sporting activities offered by ‘Sports Programme’,

can swim 25 metres, is able to submerge themselves for water sports and declare on my honour being in possession of a swimming certificate,

and undertake to comply with the terms set out in this charter.

to be collected at the end of each session by Mr or Mrs

to be the responsibility of the activity leaders, who will take all necessary measures in the event of an accident,

OTHER PERSON TO CONTACT IN CASE OF EMERGENCY

Telephone number

First and last name

FORMULE SPORTS

During summer and on dedicated time slots, the

municipal Youth and Sports department offers

free sports activities open to all*. Participation by

minors requires a parental authorisation.

Registration for activities must be done

by telephone : +33 06 45 74 06 46*. The

municipal Youth and Sports department

reserves the right to amend the programme

of activities depending on weather conditions.

*Unless otherwise stated in the the programme of activities.p. 2

DISCLOSURE OF THE MINOR’S PERSONAL DATA

AUTHORISATION FOR VISUAL RECORDING

I consent to the processing of my child's personal data provided to the municipal Youth and Sports department of Saint-Yrieix, which undertakes to respect its confidentiality and protect it in accordance with the law and regulations. I may withdraw my consent at any time. In accordance with the amended Data Protection Act of 6 January 1978, you have the right to access and rectify information concerning you. If you wish to exercise this right and obtain a copy of the information concerning you, please contact the department responsible for data access.

I give my consent to the municipality of Saint-Yrieix and its staff to take photos and film my child whilst they are taking part in the activities mentioned in the preamble, AND to use, reproduce and distribute the footage, free of charge, as part of its communications activities across all media, including digital platforms (the town’s website and social media).

I refuse to provide my child's personal data and do not consent to it being processed by the municipal Youth and Sports department of Saint-Yrieix. By refusing to provide my personal data, I expressly accept the consequences of not doing so, namely the possibility for the municipal Youth and Sports department to refuse participation in activities.

I do not consent to the municipality of Saint-Yrieix and its staff recording my child whilst they are taking part in the activities referred to in the preamble, nor do I consent to the municipality using, reproducing or distributing such recordings, free of charge, as part of its communications activities across all media, including digital platforms (the town’s website and social media).

Date

Signature

Please note: You must write the French phrase

‘Lu et approuvé’ (‘Read and approved’) before your

signature.

As part of their public service remit, municipal departments

are required to produce visual recordings (photographs and

videos) for educational purposes or to promote activities of

general or collective interest. The following authorisation is

intended to obtain the necessary consent and authorisations

regarding image rights arising from visual recordings,

in particular concerning their use, reproduction and

distribution. Their purpose is to support the local community's

communication activities. They will be processed by the

departments, without being used for profit or commercial

purposes. They will be retained and may be used for a period

of 3 years both nationally and internationally.

The information provided in this form is collected in

accordance with the legal obligation to protect individuals,

public interest duties and the powers exercised by the Town of

Saint-Yrieix. The Town of Saint-Yrieix expressly undertakes not

to make any unlawful use of the recordings that might infringe

upon dignity, reputation or privacy, nor to make any other use

that is detrimental under the laws and regulations in force.

In the context set out above, the use and exploitation of the

recordings by the Town shall not give rise to any remuneration

or consideration of any kind. This express consent is final and

excludes any subsequent claim for remuneration.

Pursuant to the EU Regulation known as the General Data

Protection Regulation (GDPR) of 27 April 2016 and the French

Data Protection Act of 6 January 1978, every data subject has

the right to access, rectify or even erase their data.

Furthermore, they may exercise the right to object, to data

portability or to restrict processing. For any questions

regarding the exercise of the aforementioned rights, a Data

Protection Officer has been appointed by the City: Data Vigi

Protection. It is also possible to lodge a complaint with the

CNIL, 3 place de Fontenay 75334 Paris (www.cnil.fr).

• This document, duly completed and signed.

You are responsible for the accuracy of your

answers. The Town of Saint-Yrieix cannot be held

liable for any accident resulting from a false

statement.

DOCUMENTS TO BE PROVIDED