Aanmelding - Kindcentrum De Bongerd

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)*

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?

Consent questions

Please fill with Yes or No to what applies

Ik geef toestemming om foto- of filmmateriaal van mijn kind te gebruiken voor interne doeleinden

Ik geef toestemming om foto- of filmmateriaal van mijn kind te gebruiken voor externe doeleinden (voor bv PR, krant, opdrachten stagiaires, opleidingsdoeleinden PM’s,)

Ik geef toestemming om foto- of filmmateriaal van mijn kind te gebruiken voor Social media van De Bongerd ( o.a. Facebook/twitter )

Ik geef toestemming om foto- of filmmateriaal van mijn kind te gebruiken voor website van De Bongerd

Ik geef toestemming voor het maken van uitstapjes

16444

16446

16447

16448

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)*

Reffered for VVE (Preschool education)

Personal situation

Combined income

Streetname*

House number*

House number extension

Postalcode (numbers)*

Postalcode (characters)*

City*

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*

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

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

City

Phone number (Home)

Mobilephone number

Phone number (work)

I agree with Privacy Statement

Registration for Kindcentrum De Bongerd

Requested childcare

Child

You will be able to register another child after submitting the first registration

Consent questions

Please fill with Yes or No to what applies

Parent/Guardian 1 (Who will receive the invoices)

Parent/Guardian 2

Emergency person