Complete a request

Instagram
This field is for validation purposes and should be left unchanged.
General information
Please fill out this initial contact form to allow us to evaluate your request. We will contact you to complete your file if your request is accepted. We will communicate with you as soon as possible.
Fields marked with an asterisk (*) are required

Since we are experiencing a period of high demand, for an indefinite period, we must temporarily suspend once again the possibility of submitting new requests for several of our services, in order to ensure balanced management of our waiting lists and adequately respond to this demand.

N.B Registrations FOR 5-12 SUMMER DAY CAMP must be completed in february directly through the City of Salaberry-de-Valleyfield, under the “Programme d'intégration” section.

N.B. Registration for the SUMMER DAY CAMP for ages 13–21 is available only from mid-April to mid-May.

N.B. Registration for the SPRING BREAK DAY CAMP for ages 13–21 is available only in January.
This field is hidden when viewing the form
Opening date of the request
DD slash MM slash YYYY
Select the service(s) you wish to obtain*
- A place for 0-5 and accompaniment for all
Primary parent
Name of the parent responsible for the request*
*
- Father
- Mother
- Other
Preferred language*
- French
- English
- Other
Other - Specify language
This field is hidden when viewing the form
Contact information
Home address*
Home address
City*
City
Postal code*
Postal code
Telephone*
Email*
This field is hidden when viewing the form
Secondary parent
Family name / Given name of secondary parent
- Father
- Mother

Inscription EN

General information

Primary parent

Contact information

Secondary parent

Beneficiary of the service

Status level