Aanmelding - Villa Kakelbont

Requested childcare

Via dit formulier kan je je kind aanmelden bij Villa Kakelbont in Heerhugowaard.

In de toelichting kan je aangeven welke start en eindtijden je wenst en op welke dagen. Indien de start en eindtijden tijdens de vakanties afwijken kan je dit hier ook aangeven.

Indien je gebruik wenst te maken van flexibele opvang kan dit ook hier worden aangegeven.

Wij nemen na ontvangst van de aanmelding zo spoedig mogelijk contact op.

Plaatsing is pas definitief na ontvangst en ondertekening van het contract.

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
Country of birth
Nationality
Spoken language
Religion
Gender
Citizen number (BSN)*

Nickname
School/Classroom
Allergies
Medication
Medical notes
Vaccinations
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

Is Villa Kakelbont allowed to exchange information about the development of your child with the school of your child?*
Is Villa Kakelbont allowed to exchange name and address details with the school of your child?*
My child is allowed on pictures in the diary.*
Pictures and videos of my child are allowed on Social Media*
Pictures and videos of my child can be used for the website and newsletters of Villa Kakelbont*
Is allowed to lie in a not-standard sleeping position (up till 3 months)
Is allowed to go on fieldtrips*
Is allowed to be transported by handcart, cargo bike or by foot with sufficient guidance (up till 4 years)
Is allowed to be transported to and from school with a bus, taxi of car (from 4 years on)
Is allowed to be transported to and from school by handcart, cargo bike or by foot (from 4 years on)
Is allowed to wear jewelry*
Is allowed to wear jewelry during sleeping (up till 4 years)
Zelfstandigheid: Mag op mijn verantwoordelijkheid zonder toezicht op het buitenspeelplein spelen (Vanaf 7 jaar)
Independant: Is allowed to go to an activity from the BSO or to the BSO from an activity without supervision on my responsibility (From 7 years on)
Zelfstandigheid: Mag op mijn verantwoordelijkheid zonder toezicht achterblijven in een leefruimte (Vanaf 7 jaar)
Zelfstandigheid: Mag op mijn verantwoordelijkheid zonder toezicht van school naar de BSO of van de BSO naar school (Vanaf 7 jaar)
Independant: Is allowed to go to the BSO from home or to get home from the BSO without supervision on my responsibility (From 7 years on)
I declare that personal information can be shared with the GGD for source- and contact research*
I declare that it is allowed to share my email address with the oudercommissie*
I declare that my child will or has been vaccinated according the Governmental Vaccination Program (Rijksvaccinatieprogramma)*
My child has a swimming diploma level A*
My child has a swimming diploma level B*
My child has a swimming diploma level C*
My child is allowed to have his/her face painted*
May sleep in an unusual sleeping position (until the child has mastered turning and rolling over independently)
Independant: Is allowed to play in our indoor play equipment without supervision on my responsability (From 7 years on)
16895
My child is allowed to sleep with a cuddly toy (up to 1 year old).

Parent/Guardian 1 (Who will receive the invoices)

Title
Initials*
Firstname
Last name prefix
Last name*
Relationship
Date of birth*
Country of birth
Nationality
Spoken language
Religion
Citizen Number (BSN)*
Highest education
Profession
Reffered for VVE (Preschool education)
Personal situation
Combined income
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

n.v.t

Title
Initials*
Firstname
Last name prefix
Last name*
Relationship
Date of birth*
Country of birth
Nationality
Spoken language
Religion
Citizen Number (BSN)*
Highest education
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*
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
Date of birth
Citizen number (BSN)

Street
House number
House number extension
Postalcode (numbers)
Postalcode (characters)
City
Phone number (Home)
Mobilephone number
Phone number (work)
E-mail address

Privacy Statement

Registration for Villa Kakelbont

Requested childcare

Child

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

Consent questions

Please fill with Yes or No to what applies

Parent/Guardian 1 (Who will receive the invoices)

Parent/Guardian 2

Emergency person