Aanmelding - KDV Eigen-Wijs Lochem

EN | NL

Registration for KDV Eigen-Wijs Lochem

Requested childcare

Gewenst contract:
o 52 weken opvangcontract uurtarief € 10,75
o 48 weken opvangcontract uurtarief € 11,05
o 40 weken opvangcontract uurtarief € 11,53

Plaatsing, aangeven van hoe laat tot hoe laat de opvang nodig is. U kunt de brengtijden combineren met andere haaltijden:

Mogelijkheden brengtijd, brengen ná:
7.30 uur
8.00 uur
8.30 uur

Mogelijkheden haaltijd, ophalen vóór:
16.30 uur
17.00 uur
17.30 uur
18.00 uur

Startdate*
Enddate*

Remark

Child

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

Initials
First name*
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*
Health insurance
Health insurance policy number
May be picked-up by

Doctor/General practitioner
Dentist
If your Doctor/General practitioner/Dentist 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*
Relationship
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*
BIC/SWIFT code (if applicable)

Parent/Guardian 2

Title
Initials*
Firstname*
Last name*
Relationship
Date of birth*
Spoken language
Citizen Number (BSN)*
Profession
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*
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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