Salamander Fund

Identification of the parent or legal guardian responsible for the application

First name•

Last name

Address•

Postal Code•

E-mail•

Phone number•

Identification of the second parent or legal guardian

First name

Last name

Address (if different)

Postal Code•

E-mail

Phone number

Identification - Child #1

First and last name•

Address•

Postal Code•

Date of birth•

Documents to attach

Required : Proof of residency, parental relationship, and a copy of the tax assessment notice.

Supporting documents can be presented in person at Centre Lac-Brome (270 Victoria Street) from Monday to Thursday between 10 a.m and noon. and between 1 p.m. and 4:30 p.m. or on Friday between 8 a.m. and 12 p.m.

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Acceptation - I acknowledge and certify that all the information and documents provided are true.

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Salamander Fund

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Identification of the parent or legal guardian responsible for the application

Identification of the second parent or legal guardian

Identification - Child #1

Save information