Aanmelding - BSO Fluitenkruid

EN | NL

Registration for BSO Fluitenkruid

Requested childcare

Graag onderstaand aanvinken welke dagen u opvang wilt aanvragen.
Wij bieden opvang in:
schoolweken: Maandag t/m vrijdag van 14.00 tot 18.00
Vakantieweken: Maandag, dinsdag, donderdag en vrijdag van 8.00 - 18.00

Startdate*
Enddate

Days without vacations 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
Country of birth *
Nationality
Spoken language
Gender
Citizen number (BSN)*

Nickname
School/Classroom*
Allergies
Medication
Medical notes
Vaccinations*
May be picked-up by

Consent questions

Please fill with Yes or No to what applies

*
*
*

Parent/Guardian 1 (Who will receive the invoices)

Title
Initials*
Firstname*
Last name prefix
Last name*
Relationship
Date of birth*
Country of birth
Nationality
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

n.v.t

Title
Initials*
Firstname*
Last name prefix
Last name*
Relationship
Date of birth*
Country of birth
Nationality
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*
First name*
Last name*
Relation*

House number extension
Phone number (Home)*
Mobilephone number

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