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Participation form for « free internet » program

Reference number

First name of participant

Last name of participant

Telephone number

Deuxième numéro de téléphone

Address

Apartment number

City

Postal code

How many children do you have?

How old are your children?

How old are your children?
How old are your children?

How many computers do you have at home?

How many tablets do you have at home?

Are you a single parent?

Yes

Consent to share a testimonial

I consent to being contacted by Fondation La Clé for the purpose of sharing a testimonial as part of this program. This testimonial may appear on Fondation La Clé social networks, on its website or in its annual report.

Consent to disclosure of personal information with Fondation La Clé and Vidéotron

I consent to the Fondation La Clé sharing my name, address, e-mail address and telephone number(s) with the Internet service provider Videotron, in order to benefit from the "free Internet" program offered by Fondation La Clé.

Par le fait même, j’autorise Vidéotron à me contacter dans le cadre de ces services. Ce consentement est valide tant et aussi longtemps que je serai admissible au programme « connexion internet gratuite » offert par la Fondation La Clé.

Je comprends que si je refuse de donner ce consentement, je ne pourrai pas être éligible à l’offre proposée par la Fondation La Clé.

Consent to disclosure of personal information with Office municipal d'habitation de Montréal

I also consent to Fondation La Clé sharing my personal information with the Office municipal d'habitation de Montréal, as part of the "free Internet" program, if necessary.

Participant's declaration of understanding and compliance

I have read the terms and conditions of participation and the general rules of the call for applications for the "free internet" program and I therefore undertake to comply with them.

I declare that all the information provided in this form is accurate and complete.

Are you sure you want to cancel this request?

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