Aanmelding - Peuterschool Beregoed

EN | NL

Registration for Peuterschool Beregoed

Requested childcare

Per inschrijving vragen wij een bijdrage van €25. Dit bedrag, waarmee uw inschrijving definitief wordt, kan worden overgemaakt naar rekening nummer NL45 RABO0368021610 tnv Stichting Peuterschool Beregoed o.v.v. “inschrijving [naam kind]”.

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
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*
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
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

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