Aanmelding - Greenkidzz Zuid

EN | NL

Registration for Greenkidzz Zuid

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
Gender
Citizen number (BSN)

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

Doctor/General practitioner
If your Doctor/General practitioner 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 u toestemming om de nieuwsbrief en e-mails te ontvangen ?

Parent/Guardian 1 (Who will receive the invoices)

Title
Initials*
Firstname*
Last name prefix
Last name*
Relationship
Date of birth*
Citizen Number (BSN)*
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
Citizen Number (BSN)
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

First name
Last name prefix
Last name
Relation
Date of birth

House number
Mobilephone number
Phone number (work)
E-mail address

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