Aanmelding - de Clercq

EN | NL

Registration for de Clercq

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
Gender*

Nickname*
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

Title
Initials
Firstname
Last name prefix
Last name
Citizen Number (BSN)
BIC/SWIFT code (if applicable)

Emergency person

First name
Last name
Relation

Privacy Statement