Aanmelding - Eigenwijs

EN | NL

Registration for Eigenwijs

Requested childcare

"Leuk dat je hebt gekozen voor Kindercentrum Eigenwijs!

Via dit formulier kun je jouw kindje(s) opgeven voor onze dagopvang óf peuteropvang. Wij zijn maandag tot en met vrijdag geopend van 07.00 uur tot 18.30 uur.

Als je meer dan één kind wilt aanmelden volg je eerst de gehele inschrijfprocedure voor het eerste kind. Nadat je het formulier hebt verstuurd kun je het volgende kind aanmelden. Eventuele bijzonderheden kun je in het vak toelichting vermelden.

Voor vragen kun je contact met ons opnemen via info@kindercentrumeigenwijs.nl.".

Startdate*
Enddate*

Full day childcare (KDV) Monday Tuesday Wednesday Thursday Friday

Toddlercare in the morning (PO) Monday Tuesday Wednesday Thursday Friday

Toddlercare in the afternoon (PO) Monday Tuesday Wednesday Thursday Friday

Days including vacations Monday Tuesday Wednesday Thursday Friday

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
Spoken language
Gender
Citizen number (BSN)*

Nickname
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

mag uw kindje mee op uitstapjes? ( wandelen)*
mag uw kindje op social media?*
Mag uw kindje buiten slapen? *
mag uw kindje meefeesten met alle feestdagen? *
Mag uw kindje mee in de zindelijkheids training?*
Mag uw kindje op zijn/haar buik slapen?*

Parent/Guardian 1 (Who will receive the invoices)

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

City
Phone number (Home)
Mobilephone number
Phone number (work)
E-mail address

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