Aanmelding - Peuterspeelzaal De Piraatjes

EN | NL

Registration for Peuterspeelzaal De Piraatjes

Requested childcare

Graag onderstaand de betreffende gegevens invullen en uw aanvraag verzenden. U krijgt zo spoedig mogelijk een reactie.

De gegevens met een * zijn verplicht.

Bij noodpersoon invullen wanneer uw kind niet door een ouder wordt opgehaald. Bv een opa of oma.

Op dinsdag is er geen peuteropvang

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*
Gender*
Citizen number (BSN)*

Nickname*
Allergies
Medication
Medical notes
Vaccinations*
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

Foto's van mijn kind mogen gebruikt worden voor de website/facebook en intern gebruik?
Kind doet mee met rijks vaccinatieprogramma?

Parent/Guardian 1 (Who will receive the invoices)

Title
Initials*
Firstname
Last name prefix
Last name*
Relationship
Date of birth*
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

Title
Initials
Firstname
Last name prefix
Last name
Relationship
Date of birth
Nationality
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

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