Aanmelding - Kinderopvang Yuki & Ko

EN | NL

Registration for Kinderopvang Yuki & Ko

Requested childcare

Om uw inschrijving te voltooien, vragen wij u een bedrag van €25,00 over te maken naar onderstaand rekening nummer:

Rekeningnummer: NL89 RABO 0148 0920 39 Ten name van: Kinderopvang Yuki & Ko V.o.f.

Uw inschrijving wordt definitief verwerkt zodra het bedrag is ontvangen.

Alvast hartelijk dan voor uw betaling.

Startdate*
Enddate*

Remark

Child

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

Initials
First name*
Last name prefix
Last name*

Date of birth
Estimated date of birth / Not yet born
Country of birth
Nationality
Gender
Citizen number (BSN)

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

17185
17186
17187
17188
17189
17190
17191

Parent/Guardian 1 (Who will receive the invoices)

Title
Initials*
Firstname*
Last name prefix
Last name*
Relationship
Date of birth*
Citizen Number (BSN)*
Profession
Streetname*
House number*
House number extension
Postalcode (numbers)*
Postalcode (characters)*
City*
Phone number (Home)
Mobile phone number*
Phonenumber (work)
E-mail address*
IBAN*

Parent/Guardian 2

n.v.t

Title
Initials
Firstname
Last name prefix
Last name
Relationship
Date of birth
Citizen Number (BSN)
Profession
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
Phone number (Home)
Mobile phone number
Phonenumber (work)
E-mail address

Emergency person

First name
Last name prefix
Last name
Relation

Street
House number
House number extension
Postalcode (numbers)
Postalcode (characters)
City
Phone number (Home)
Mobilephone number
Phone number (work)

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