Aanmelding - Kinderopvang Onder de Pannen Peuterspeelzaal Hummelhonk

EN | NL

Registration for Kinderopvang Onder de Pannen Peuterspeelzaal Hummelhonk

Requested childcare

Peuterspeelzaal Hummelhonk is geopend tijdens schoolweken op dinsdag en donderdag van 08.30 -12.00 uur.

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*
Phonenumber (Incase of emergency)

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

Nickname
Allergies
Medical notes
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

Mijn kind volgt het rijksvaccinatieprogramma*
Ik geef toestemming voor uitstapjes met de auto*
Ik geef toestemming voor uitstapjes te voet*
Ik geef toestemming voor foto's in de ouderapp (alleen zichtbaar voor ouders))*

Parent/Guardian 1 (Who will receive the invoices)

Title*
Initials*
Firstname*
Last name prefix
Last name*
Relationship
Date of birth*
Nationality
Spoken language
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*
Nationality
Spoken language
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

Title
Initials
First name
Last name prefix
Last name
Relation

Phone number (Home)
Mobilephone number

Privacy Statement