Aanmelding - De Peuterboerderij

EN | NL

Registration for De Peuterboerderij

Requested childcare

Beste ouder(s)/verzorger(s),

Wilt u bij de toelichting aangeven of u gebruik wilt maken van pakket 1 (na 08.00 uur- 18.00 uur) of pakket 2 ( na 07.00 uur- 18.00 uur). Zie voor uitleg de pagina 'tarieven' op de website.

Het is voor ons belangrijk om alle gegevens compleet te hebben. Wilt u als noodpersoon een andere persoon kiezen dan de ouders? Uiteraard bellen wij altijd eerst ouders, maar wanneer zij niet bereikbaar zijn, is het prettig een opa/oma/buurvrouw etc. te kunnen bellen.

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
Country of birth *
Spoken language*
Religion
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?

Parent/Guardian 1 (Who will receive the invoices)

Initials*
Firstname*
Last name prefix
Last name*
Relationship*
Date of birth*
Country of birth *
Spoken language*
Religion
Citizen Number (BSN)*
Profession
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

n.v.t

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

Emergency person

Title*
Last name prefix
Last name*
Relation*

Phone number (Home)
Mobilephone number*
Phone number (work)

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