Aanmelding - Laarsjes in de Polder

EN | NL

Registration for Laarsjes in de Polder

Requested childcare

Schrijf je een ongeboren kindje in? Als je aanvinkt dat het om een geschatte geboortedatum (uitgerekende datum) gaat, hoef je geen burgerservicenummer in te vullen. Verder kun je je kindje inschrijven met 'B.' als initiaal, 'Baby' als voornaam en de betreffende achternaam. Richting plaatsing, zullen we het contract met alle juiste gegevens opmaken.

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*

Date of birth*
Estimated date of birth / Not yet born
Spoken language
Gender
Citizen number (BSN)*

Medical notes
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?

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)*
Streetname
House number
House number extension
Postalcode (numbers)
Postalcode (characters)
City
Country
Phone number (Home)
Mobile phone number
Phonenumber (work)
E-mail address
IBAN

Parent/Guardian 2

Title
Initials
Firstname
Last name prefix
Last name
Relationship
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

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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