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
Spoken language
Gender
Citizen number (BSN)*

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

Parent/Guardian 1 (Who will receive the invoices)

Title
Initials
Firstname*
Last name prefix
Last name*
Date of birth*
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
Date of birth
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
Date of birth
Citizen number (BSN)

Street
House number
House number extension
Postalcode (numbers)
Postalcode (characters)
City
Phone number (Home)
Mobilephone number
Phone number (work)
E-mail address

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