Aanmelding - Agrarisch kinderdagverblijf De Dierenvriendjes B.V.

EN | NL

Registration for Agrarisch kinderdagverblijf De Dierenvriendjes B.V.

Requested childcare

Bij einddatum vult u de datum in dat uw kind 4 jaar wordt. Indien u het contract eerder wilt beëindigen kan dit ten alle tijden met een opzegtermijn van 1 maand.

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
Spoken language
Gender
Citizen number (BSN)

Nickname
Allergies
Medication
Medical notes
Vaccinations
Health insurance
Health insurance policy number
May be picked-up by

Consent questions

Please fill with Yes or No to what applies

Rijksvaccinatie

Parent/Guardian 1 (Who will receive the invoices)

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

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

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