Aanmelding - Tante Jansz - Kinderopvang it Pikehok

EN | NL

Registration for Tante Jansz - Kinderopvang it Pikehok

Requested childcare

In de toelichting kunt u aangeven of u 51 of 40 weken opvang wilt.

Startdate*
Enddate*

Full day childcare (KDV) Monday Tuesday Wednesday Thursday Friday

Flexible Monday Tuesday Wednesday Thursday Friday

Remark

Child

You will be able to register another child after submitting the first registration

Initials*
First name*
Last name prefix
Last name*
Phonenumber (Incase of emergency)

Date of birth*
Estimated date of birth / Not yet born
Spoken language
Gender
Citizen number (BSN)*

Nickname
Allergies
Medication
Medical notes
Vaccinations
Health insurance
Health insurance policy number
May be picked-up by

Doctor/General practitioner
Dentist
If your Doctor/General practitioner/Dentist is not mentioned in the list, can you please write them in the remark field above?

Consent questions

Please fill with Yes or No to what applies

Geeft toestemming voor het publiceren van foto's op Facebook.
Geeft toestemming voor het publiceren van foto's op de website.
Geeft toestemming voor het ondernemen van uitjes per auto/bus.
Geeft toestemming voor het kind om buiten te slapen.

Parent/Guardian 1 (Who will receive the invoices)

Title*
Initials*
Firstname
Last name prefix
Last name*
Relationship
Date of birth*
Spoken language
Citizen Number (BSN)*
Highest education
Streetname*
House number*
House number extension
Postalcode (numbers)*
Postalcode (characters)*
City*
Country
Phone number (Home)
Mobile phone number*
Phonenumber (work)
E-mail address*
IBAN
BIC/SWIFT code (if applicable)

Parent/Guardian 2

Title
Initials
Firstname
Last name prefix
Last name
Relationship
Date of birth
Spoken language
Citizen Number (BSN)
Highest education
If you do not enter an address here, the address of parent/guardian 1 will be automatically taken over.
Streetname
House number
House number extension
Postalcode (numbers)
Postalcode (characters)
City
Country
Phone number (Home)
Mobile phone number
Phonenumber (work)
E-mail address
BIC/SWIFT code (if applicable)

Emergency person

Title
Initials
First name
Last name prefix
Last name
Relation

City
Phone number (Home)
Mobilephone number
Phone number (work)
E-mail address

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