Aanmelding - Kyra de Vrije Ruimte

EN | NL

Registration for Kyra de Vrije Ruimte

Requested childcare

Lieve ouders/verzorgers,

Wat leuk dat je je wil inschrijven bij Kyra de Vrije Ruimte! Om je inschrijving in orde te maken, vragen we je alle gegevens zorgvuldig in te vullen.

Voor een toelichting bij het kopje 'toestemmingen' kun je kijken op deze pagina.

Wij nemen binnenkort contact op over de plaatsingsmogelijkheden.

Met warme groet,

Marlijn & Eva Eigenaressen Kleinschalige Kinderopvang Kyra

Startdate*
Enddate*

Full day childcare (KDV) Monday Tuesday Wednesday Thursday Friday

Flexible Monday Tuesday Wednesday Thursday Friday

Remark

Child

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

First name*
Last name prefix
Last name*

Date of birth*
Estimated date of birth / Not yet born
Country of birth
Nationality*
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

17178
17179
17180
17181
17182
17183
17184

Parent/Guardian 1 (Who will receive the invoices)

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

n.v.t

Title
Initials
Firstname*
Last name prefix
Last name*
Relationship*
Date of birth*
Nationality
Spoken language*
Religion
Citizen Number (BSN)*
If you do not enter an address here, the address of parent/guardian 1 will be automatically taken over.
House number
House number extension
Postalcode (numbers)
Postalcode (characters)
City
Country
Phone number (Home)
Mobile phone number*
Phonenumber (work)
E-mail address*

Emergency person

First name
Last name prefix
Last name
Relation

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

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