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font-size: inherit; font-weight: inherit; height: 24px; } .formtastic input[type='submit']{ height: 24px; } .logo { background-image: url(https://kdvnet3.s3.amazonaws.com/uploads/5fbfa5c0-9b11-443d-80a9-c905c5959163/Logo-Flekss%5B1%5D.png); background-position: 0 0; background-repeat: no-repeat; } </style> <div class='external' id='content'> <div id='top'> <div id='flash'> <div class="flash-message" id="flash-message" style="width: 47%;"></div><script>$('.flash-message').show();</script> <!--[if lt IE 8]> <p class='error'> U maakt gebruik van een verouderde versie van Internet Explorer. U wordt geadviseerd om de nieuwste versie te downloaden en te installeren! </p> <![endif]--> </div> </div> <div class='logo_container logo'></div> <a class='language-link' data-locale='en' href='/external/registrations/new?locale=en&registration_token=qDlF4OPjY8GHtWtqnqOA'>EN</a> | NL <div id='new_child_form'> <h2>Aanmelding voor Sport-BSO Flekss - De Fontein</h2> <h3></h3> <form accept-charset="UTF-8" action="/external/registrations" class="formtastic registration" id="new_registration" method="post" novalidate="novalidate"><div style="margin:0;padding:0;display:inline"><input name="utf8" type="hidden" value="✓" /><input name="authenticity_token" type="hidden" value="Q9mWRtF+cqGo4mA8rIR7B9AasQMY3eFQP75fWp2Bazo=" /></div><input id="registration_token" name="registration_token" type="hidden" value="qDlF4OPjY8GHtWtqnqOA" /> <div class='form_group' id='parent'> <h3 class='registration'>Toelichting</h3> <h4><p>Toelichting:</p> <ul> <li>VSO staat voor voorschoolse opvang</li> <li>NSO staat voor naschoolse opvang</li> <li>Dagen inclusief vakantie kunt u in combinatie met 'NSO' invullen als u tijdens de schooldagen en vakantiedagen opvang wenst (het huidige comfort pakket)</li> </ul> <p>Het 52 weken pakket (compleet pakket - inclusief vakantie) is in vele gevallen voordeliger dan het 40 weken pakket (basis). Wij helpen u graag met de berekening van de eigen bijdrage.</p> <p>Mocht u vragen hebben kunt u altijd bellen/appen met ons serviceteam (076-3034242) of mailen naar <a href="mailto:info@flekss.nl">info@flekss.nl</a></p> <p>Op basis van onderstaande gegevens stellen wij een contract op. Hoe eerder u zich inschrijft, hoe groter de kans dat u sneller een plek krijgt!</p> <p>Voor actuele tijden en prijzen zie <a href="http://www.flekss.nl">www.flekss.nl</a>.</p> </h4> <br> <fieldset class="inputs"><ol><li class="string input required stringish" id="registration_preferred_start_date_input"><label class=" label" for="registration_preferred_start_date">Startdatum<abbr title="required">*</abbr></label><input id="registration_preferred_start_date" name="registration[preferred_start_date]" type="text" /> </li> <li class="string input optional stringish" id="registration_preferred_end_date_input"><label class=" label" for="registration_preferred_end_date">Einddatum</label><input id="registration_preferred_end_date" name="registration[preferred_end_date]" type="text" /> </li> </ol></fieldset><fieldset class='inputs'> <ol> <li class='input'> <label class='label'>Dagen VSO</label> <input id="monday_vso" name="monday_vso" type="checkbox" value="true" /> Maandag <input id="tuesday_vso" name="tuesday_vso" type="checkbox" value="true" /> Dinsdag <input id="wednesday_vso" name="wednesday_vso" type="checkbox" value="true" /> Woensdag <input id="thursday_vso" name="thursday_vso" type="checkbox" value="true" /> Donderdag <input id="friday_vso" name="friday_vso" type="checkbox" value="true" /> Vrijdag </li> </ol> </fieldset> <fieldset class='inputs'> <ol> <li class='input'> <label class='label'>Dagen NSO</label> <input id="monday_nso" name="monday_nso" type="checkbox" value="true" /> Maandag <input id="tuesday_nso" name="tuesday_nso" type="checkbox" value="true" /> Dinsdag <input id="wednesday_nso" name="wednesday_nso" type="checkbox" value="true" /> Woensdag <input id="thursday_nso" name="thursday_nso" type="checkbox" value="true" /> Donderdag <input id="friday_nso" name="friday_nso" type="checkbox" value="true" /> Vrijdag </li> </ol> </fieldset> <fieldset class='inputs'> <ol> <li class='input'> <label class='label'>Dagen incl. vakantie</label> <input id="monday_holiday" name="monday_holiday" type="checkbox" value="true" /> Maandag <input id="tuesday_holiday" name="tuesday_holiday" type="checkbox" value="true" /> Dinsdag <input id="wednesday_holiday" name="wednesday_holiday" type="checkbox" value="true" /> Woensdag <input id="thursday_holiday" name="thursday_holiday" type="checkbox" value="true" /> Donderdag <input id="friday_holiday" name="friday_holiday" type="checkbox" value="true" /> Vrijdag </li> </ol> </fieldset> <fieldset class='inputs'> <ol> <li class='input'> <label class='label'>Alleen vakantieopvang</label> <input id="monday_only_holiday" name="monday_only_holiday" type="checkbox" value="true" /> Maandag <input id="tuesday_only_holiday" name="tuesday_only_holiday" type="checkbox" value="true" /> Dinsdag <input id="wednesday_only_holiday" name="wednesday_only_holiday" type="checkbox" value="true" /> Woensdag <input id="thursday_only_holiday" name="thursday_only_holiday" type="checkbox" value="true" /> Donderdag <input id="friday_only_holiday" name="friday_only_holiday" type="checkbox" value="true" /> Vrijdag </li> </ol> </fieldset> <fieldset class="inputs"><ol><li class="text input optional" id="registration_remarks_input"><label class=" label" for="registration_remarks">Toelichting</label><textarea id="registration_remarks" name="registration[remarks]" rows="20"> </textarea> </li> </ol></fieldset> </div> <div class='clear'></div> <div class='form_group' id='parent'> <h3 class='registration'>Kind</h3> <h4>U kunt eventueel nog een kind registreren na het invoeren van deze aanmelding</h4> <fieldset class="inputs"><ol><li class="string input required stringish" id="registration_child_attributes_initials_input"><label class=" label" for="registration_child_attributes_initials">Initialen<abbr title="required">*</abbr></label><input id="registration_child_attributes_initials" maxlength="10" name="registration[child_attributes][initials]" type="text" /> </li> <li class="string input required stringish" id="registration_child_attributes_firstname_input"><label class=" label" for="registration_child_attributes_firstname">Voornaam<abbr title="required">*</abbr></label><input id="registration_child_attributes_firstname" maxlength="255" name="registration[child_attributes][firstname]" type="text" /> </li> <li class="string input optional stringish" id="registration_child_attributes_in_between_first_and_lastname_input"><label class=" label" for="registration_child_attributes_in_between_first_and_lastname">Tussenvoegsel</label><input id="registration_child_attributes_in_between_first_and_lastname" maxlength="10" name="registration[child_attributes][in_between_first_and_lastname]" type="text" /> </li> <li class="string input required stringish" id="registration_child_attributes_lastname_input"><label class=" label" for="registration_child_attributes_lastname">Achternaam<abbr title="required">*</abbr></label><input id="registration_child_attributes_lastname" maxlength="255" name="registration[child_attributes][lastname]" type="text" /> </li> <li class="string input required stringish" id="registration_child_attributes_emergency_phone_input"><label class=" label" for="registration_child_attributes_emergency_phone">Telefoon (bij nood)<abbr title="required">*</abbr></label><input id="registration_child_attributes_emergency_phone" maxlength="255" name="registration[child_attributes][emergency_phone]" type="text" /> </li> </ol></fieldset><fieldset class="inputs"><ol><li class="string input required stringish" id="registration_child_attributes_date_of_birth_input"><label class=" label" for="registration_child_attributes_date_of_birth">Geboortedatum<abbr title="required">*</abbr></label><input id="registration_child_attributes_date_of_birth" name="registration[child_attributes][date_of_birth]" type="text" /> </li> <li class='string input optional stringish' id='registration_child_attributes_disable_bsnr_input'> <label class='label' for='registration_child_attributes_disable_bsnr'> Geschatte geboortedatum </label> <input name="registration[child_attributes][disable_bsnr]" type="hidden" value="0" /><input id="registration_child_attributes_disable_bsnr" name="registration[child_attributes][disable_bsnr]" type="checkbox" value="1" /> </li> <li class="select input required" id="registration_child_attributes_gender_input"><label class=" label" for="registration_child_attributes_gender">Geslacht<abbr title="required">*</abbr></label><select id="registration_child_attributes_gender" name="registration[child_attributes][gender]"><option value=""></option> <option value="M">man</option> <option value="V">vrouw</option> <option value="N">neutraal</option> <option value="-">nog onbekend</option></select> </li> <li class="string input required stringish" id="registration_child_attributes_bsnr_input"><label class=" label" for="registration_child_attributes_bsnr">Burgerservicenummer (BSN)<abbr title="required">*</abbr></label><input id="registration_child_attributes_bsnr" maxlength="9" name="registration[child_attributes][bsnr]" type="text" /> </li> </ol></fieldset><fieldset class="inputs"><ol><li class="string input required stringish" id="registration_child_attributes_nickname_input"><label class=" label" for="registration_child_attributes_nickname">Roepnaam<abbr title="required">*</abbr></label><input id="registration_child_attributes_nickname" maxlength="255" name="registration[child_attributes][nickname]" type="text" /> </li> <li class="select input required" id="registration_child_attributes_class_room_input"><label class=" label" for="registration_child_attributes_class_room_id">Klas/School<abbr title="required">*</abbr></label><select id="registration_child_attributes_class_room_id" name="registration[child_attributes][class_room_id]"><option value=""></option> <option value="167005">Andere School - - Groep 1 t/m 8 - </option> <option value="166363">De Fontein (Kameelstraat) - Breda - Groep 1 t/m 8 - </option> <option value="167004">De Fontein (Vincidor) - Breda - Groep 1 t/m 8 - </option> <option value="166362">De Tweesprong - Breda - Groep 1 t/m 8 - </option> <option value="166364">Dirk van Veen - Breda - Groep 1 t/m 8 - </option> <option value="168789">Dokter de Visser - Serrarislaan - Breda - Groep 1 tm 8 - </option> <option value="168787">Dokter de Visser - Viandenlaan - Breda - Groep 1 tm 8 - </option> <option value="167200">Externe locatie - - Groep 1 t/m 8 - </option> <option value="167366">Fontein - Neuborgstraat 13 - Breda - Groep 1 t/m 8 - </option> <option value="167002">Het Kasteel - Breda - Groep 1 t/m 8 - </option> <option value="168790">Jacinta - Breda - Groep 1 tm 8 - </option> <option value="167365">JoKi-C MKD - Breda - Groep 1 t/m 8 - </option> <option value="168786">Laurentius - Van Gaverenlaan - Breda - Groep 1 tm 8 - </option> <option value="168788">Laurentius-Viandenlaan - Breda - Groep 1 tm 8 - </option> <option value="167003">Sint Joseph - Breda - Groep 1 t/m 8 - </option> <option value="166361">Weilust - Breda - Groep 1 t/m 8 - </option></select> </li> <li class="text input optional" id="registration_child_attributes_allergy_notes_input"><label class=" label" for="registration_child_attributes_allergy_notes">Allergieën</label><textarea id="registration_child_attributes_allergy_notes" name="registration[child_attributes][allergy_notes]" rows="20"> </textarea> </li> <li class="text input optional" id="registration_child_attributes_drugs_notes_input"><label class=" label" for="registration_child_attributes_drugs_notes">Medicatie</label><textarea id="registration_child_attributes_drugs_notes" name="registration[child_attributes][drugs_notes]" rows="20"> </textarea> </li> <li class="text input optional" id="registration_child_attributes_medical_notes_input"><label class=" label" for="registration_child_attributes_medical_notes">Medische gegevens</label><textarea id="registration_child_attributes_medical_notes" name="registration[child_attributes][medical_notes]" rows="20"> </textarea> </li> <li class="string input optional stringish" id="registration_child_attributes_pickup_person_name_input"><label class=" label" for="registration_child_attributes_pickup_person_name">Mag opgehaald worden door</label><input id="registration_child_attributes_pickup_person_name" maxlength="255" name="registration[child_attributes][pickup_person_name]" type="text" /> </li> </ol></fieldset><fieldset class="inputs"><ol><li class="select input optional" id="registration_child_attributes_doctor_input"><label class=" label" for="registration_child_attributes_doctor_id">Huisarts</label><select id="registration_child_attributes_doctor_id" name="registration[child_attributes][doctor_id]"><option value=""></option> <option value="845604">Chiropractie Baat T P, </option> <option value="845589">DEV zorg in Breda, </option> <option value="845584">Goyarts C W in Breda, </option> <option value="845590">Herwerden Huisarts P R van in Breda, </option> <option value="856018">Het Huisartsenteam Mathenessestraat, </option> <option value="856015">Huisartsen Julianalaan, </option> <option value="854171">Huisartsenpraktijk Belcrum, </option> <option value="856017">Huisartsenpraktijk Brabantpark, </option> <option value="854170">Huisartsenpraktijk Hoge Vucht, </option> <option value="845591">Huisartsenpraktijk J van Valkenburg in Breda, </option> <option value="854808">Huisartsenpraktijk Oudraad en van Riel , </option> <option value="856013">Huisartsenpraktijk Oudraad & van Riel, </option> <option value="845592">Huisartsenpraktijk Remmerswaal & Van der Schelling in Breda, </option> <option value="856012">Huisartsenpraktijk Stadshart , </option> <option value="845593">Huisartsenpraktijk StarDoc in Breda, </option> <option value="845587"> Huisartsenpraktijk Van Eerd - Gezondheidscentrum Bredero in, </option> <option value="845595">Huisartsenteam Dudok , </option> <option value="845583">Huisarts F C M W Schueler, </option> <option value="856016">Huisartspraktijk Belcrum, </option> <option value="845596">Hurk M A van den in Breda, </option> <option value="845585">Kamphoven Huisartsenpraktijk J in Breda, </option> <option value="845597">Kangangi C F M in Breda, </option> <option value="845588">Majdandzic Huisartsenpraktijk in Breda, </option> <option value="854899">Praktijk Novadok , </option> <option value="845598">Raaijmakers Huisarts J in Breda, </option> <option value="845599">Scheijmans & Laauwen Huisartsenpraktijk , </option> <option value="854326">Tandartsen Clinias , </option> <option value="854324">Tandarts > Gezonde Mooie Tanden , </option> <option value="854325">Tandheelkundig Centrum Hoge Vught, </option> <option value="845600">Waale W H E in Breda, </option> <option value="845601">Walder Huisarts Bredero Mw J I, </option> <option value="845602">Wilms Huisartsenpraktijk , </option> <option value="845603">Wolfhagen & Van Overeem Huisartsenpraktijk, </option></select> </li> <li class="select input optional" id="registration_child_attributes_dentist_input"><label class=" label" for="registration_child_attributes_dentist_id">Tandarts</label><select id="registration_child_attributes_dentist_id" name="registration[child_attributes][dentist_id]"><option value=""></option> <option value="854633">Centrum voor Tandheelkunde Breda , </option> <option value="854640">Clinias Omnident , </option> <option value="854639">Dental365 Breda, </option> <option value="854634">Mondzorg Brabant , </option> <option value="854635">Tandartsenpraktijk Van der Heijden, </option> <option value="854636">Tandartspraktijk Brandebeemd , </option> <option value="856014">Tandartspraktijk Centrum Breda, </option> <option value="854637">Tandartspraktijk MCDent, </option> <option value="854638">Tandartspraktijk Nijverheidssingel, </option> <option value="854641">Tandartspraktijk Oana Krober , </option> <option value="854642">Tandheelkundig Centrum Boeimeer , </option> <option value="854809">Tandheelkundig centrum Dudok , </option> <option value="854900">Tandheelkundig Centrum Hoge Vught , </option></select> </li> <li> <p class='inline-hints'>Als uw Huisarts/Tandarts niet vermeld wordt, wilt u dan de naam vermelden bovenaan bij de toelichting?</p> </li> </ol></fieldset> </div> <div class='form_group' id='parent'> <h3 class='registration'>Toestemmingen</h3> <h4>Selecteer wat van toepassing is</h4> <fieldset class="inputs"><ol><li> <li class="select input required" id="registration_consent_14535_input"><label class=" label" for="registration_consent_14535">(Indien van toepassing) Mijn kind mag zelfstandig van school naar de BSO en van de BSO naar huis<abbr title="required">*</abbr></label><select class="consent-required" id="registration_consent_14535" name="registration[consent][14535]"><option value=""></option> <option value="Ja">Ja</option> <option value="Nee">Nee</option></select> </li> </li> <li> <li class="select input required" id="registration_consent_14536_input"><label class=" label" for="registration_consent_14536">Mag Flekss ontwikkelingsgegevens uitwisselen met de school van uw kind?<abbr title="required">*</abbr></label><select class="consent-required" id="registration_consent_14536" name="registration[consent][14536]"><option value=""></option> <option value="Ja">Ja</option> <option value="Nee">Nee</option></select> </li> </li> <li> <li class="select input required" id="registration_consent_14538_input"><label class=" label" for="registration_consent_14538">Mag er beeldmateriaal van uw kind geplaatst worden op de Social media-accounts/website van Flekss?<abbr title="required">*</abbr></label><select class="consent-required" id="registration_consent_14538" name="registration[consent][14538]"><option value=""></option> <option value="Ja">Ja</option> <option value="Nee">Nee</option></select> </li> </li> </ol></fieldset> </div> <div class='form_group' id='parent'> <h3 class='registration'>Ouder/verzorger 1 (Waar de rekening naar gestuurd wordt.)</h3> <fieldset class="inputs"><ol> <li class="string input required stringish" id="registration_parents_attributes_initials_1_input"><label class=" label" for="registration_parents_attributes_initials_1">Initialen<abbr title="required">*</abbr></label><input id="registration_parents_attributes_initials_1" maxlength="10" name="registration[parents_attributes][initials_1]" size="10" type="text" /> </li> <li class="string input required stringish" id="registration_parents_attributes_firstname_1_input"><label class=" label" for="registration_parents_attributes_firstname_1">Voornaam<abbr title="required">*</abbr></label><input id="registration_parents_attributes_firstname_1" maxlength="60" name="registration[parents_attributes][firstname_1]" type="text" /> </li> <li class="string input optional stringish" id="registration_parents_attributes_in_between_first_and_lastname_1_input"><label class=" label" for="registration_parents_attributes_in_between_first_and_lastname_1">Tussenvoegsel</label><input id="registration_parents_attributes_in_between_first_and_lastname_1" maxlength="10" name="registration[parents_attributes][in_between_first_and_lastname_1]" size="10" type="text" /> </li> <li class="string input required stringish" id="registration_parents_attributes_lastname_1_input"><label class=" label" for="registration_parents_attributes_lastname_1">Achternaam<abbr title="required">*</abbr></label><input id="registration_parents_attributes_lastname_1" maxlength="60" name="registration[parents_attributes][lastname_1]" type="text" /> </li> <li class="select input optional" id="registration_parents_attributes_function_1_input"><label class=" label" for="registration_parents_attributes_function_1">Relatie</label><select id="registration_parents_attributes_function_1" name="registration[parents_attributes][function_1]"><option value=""></option> <option value="father">Vader</option> <option value="mother">Moeder</option> <option value="stepparent">Stiefouder</option> <option value="bonusparent">Bonusouder</option> <option value="caretakers">Noodpersonen</option> <option value="grandfather">Opa/oma</option> <option value="contactperson">Contactpersoon</option> <option value="other">Overig</option></select> </li> <li class="string input required stringish" id="registration_parents_attributes_date_of_birth_1_input"><label class=" label" for="registration_parents_attributes_date_of_birth_1">Geboortedatum<abbr title="required">*</abbr></label><input id="registration_parents_attributes_date_of_birth_1" name="registration[parents_attributes][date_of_birth_1]" type="text" /> </li> <li class="string input required stringish" id="registration_parents_attributes_bsnr_1_input"><label class=" label" for="registration_parents_attributes_bsnr_1">Burgerservicenummer (BSN)<abbr title="required">*</abbr></label><input id="registration_parents_attributes_bsnr_1" maxlength="9" name="registration[parents_attributes][bsnr_1]" size="9" type="text" /> </li> <li class="string input required stringish" id="registration_parents_attributes_street_1_input"><label class=" label" for="registration_parents_attributes_street_1">Straat<abbr title="required">*</abbr></label><input id="registration_parents_attributes_street_1" maxlength="60" name="registration[parents_attributes][street_1]" type="text" /> </li> <li class="string input required stringish" id="registration_parents_attributes_number_1_input"><label class=" label" for="registration_parents_attributes_number_1">Huisnummer<abbr title="required">*</abbr></label><input id="registration_parents_attributes_number_1" maxlength="10" name="registration[parents_attributes][number_1]" size="10" type="text" /> </li> <li class="string input optional stringish" id="registration_parents_attributes_extension_1_input"><label class=" label" for="registration_parents_attributes_extension_1">Huisnummertoevoeging</label><input id="registration_parents_attributes_extension_1" maxlength="10" name="registration[parents_attributes][extension_1]" size="10" type="text" /> </li> <li class="string input required stringish" id="registration_parents_attributes_postcode_nrs_1_input"><label class=" label" for="registration_parents_attributes_postcode_nrs_1">Postcode (cijfers)<abbr title="required">*</abbr></label><input id="registration_parents_attributes_postcode_nrs_1" maxlength="5" name="registration[parents_attributes][postcode_nrs_1]" type="text" /> </li> <li class="string input required stringish" id="registration_parents_attributes_postcode_chars_1_input"><label class=" label" for="registration_parents_attributes_postcode_chars_1">Postcode (letters)<abbr title="required">*</abbr></label><input id="registration_parents_attributes_postcode_chars_1" maxlength="2" name="registration[parents_attributes][postcode_chars_1]" size="2" style="text-transform: uppercase;" type="text" /> </li> <li class="string input required stringish" id="registration_parents_attributes_city_1_input"><label class=" label" for="registration_parents_attributes_city_1">Woonplaats<abbr title="required">*</abbr></label><input id="registration_parents_attributes_city_1" maxlength="60" name="registration[parents_attributes][city_1]" type="text" /> </li> <li class="string input optional stringish" id="registration_parents_attributes_phone_1_input"><label class=" label" for="registration_parents_attributes_phone_1">Telefoon (thuis)</label><input id="registration_parents_attributes_phone_1" maxlength="255" name="registration[parents_attributes][phone_1]" type="text" /> </li> <li class="string input required stringish" id="registration_parents_attributes_mobile_1_input"><label class=" label" for="registration_parents_attributes_mobile_1">Mobiel<abbr title="required">*</abbr></label><input id="registration_parents_attributes_mobile_1" maxlength="255" name="registration[parents_attributes][mobile_1]" type="text" /> </li> <li class="email input required stringish" id="registration_parents_attributes_email_1_input"><label class=" label" for="registration_parents_attributes_email_1">Email<abbr title="required">*</abbr></label><input id="registration_parents_attributes_email_1" maxlength="60" name="registration[parents_attributes][email_1]" size="20" type="email" /> </li> <li class="string input required stringish" id="registration_parents_attributes_iban_1_input"><label class=" label" for="registration_parents_attributes_iban_1">IBAN nummer<abbr title="required">*</abbr></label><input id="registration_parents_attributes_iban_1" maxlength="255" name="registration[parents_attributes][iban_1]" type="text" /> </li> <li class="string input optional stringish" id="registration_parents_attributes_bic_code_1_input"><label class=" label" for="registration_parents_attributes_bic_code_1">BIC code</label><input id="registration_parents_attributes_bic_code_1" maxlength="255" name="registration[parents_attributes][bic_code_1]" type="text" /> </li> <li class="hidden input optional" id="registration_parents_attributes_which_debtor_input"><input id="registration_parents_attributes_which_debtor" name="registration[parents_attributes][which_debtor]" type="hidden" value="1" /> </li> </ol></fieldset> </div> <div class='clear'></div> <div class='form_group' id='parent2'> <h3 class='registration' style='display: inline-block;'>Ouder/verzorger 2</h3> <input id="parent2_not_applicable" name="parent2_not_applicable" type="checkbox" value="true" /> <label for="parent2_not_applicable">n.v.t</label> <fieldset class="inputs"><ol> <li class="string input optional stringish" id="registration_parents_attributes_initials_2_input"><label class=" label" for="registration_parents_attributes_initials_2">Initialen</label><input id="registration_parents_attributes_initials_2" maxlength="10" name="registration[parents_attributes][initials_2]" size="10" type="text" /> </li> <li class="string input optional stringish" id="registration_parents_attributes_firstname_2_input"><label class=" label" for="registration_parents_attributes_firstname_2">Voornaam</label><input id="registration_parents_attributes_firstname_2" maxlength="60" name="registration[parents_attributes][firstname_2]" type="text" /> </li> <li class="string input optional stringish" id="registration_parents_attributes_in_between_first_and_lastname_2_input"><label class=" label" for="registration_parents_attributes_in_between_first_and_lastname_2">Tussenvoegsel</label><input id="registration_parents_attributes_in_between_first_and_lastname_2" maxlength="10" name="registration[parents_attributes][in_between_first_and_lastname_2]" size="10" type="text" /> </li> <li class="string input optional stringish" id="registration_parents_attributes_lastname_2_input"><label class=" label" for="registration_parents_attributes_lastname_2">Achternaam</label><input id="registration_parents_attributes_lastname_2" maxlength="60" name="registration[parents_attributes][lastname_2]" type="text" /> </li> <li class="string input optional stringish" id="registration_parents_attributes_date_of_birth_2_input"><label class=" label" for="registration_parents_attributes_date_of_birth_2">Geboortedatum</label><input id="registration_parents_attributes_date_of_birth_2" name="registration[parents_attributes][date_of_birth_2]" type="text" /> </li> <li class="string input optional stringish" id="registration_parents_attributes_bsnr_2_input"><label class=" label" for="registration_parents_attributes_bsnr_2">Burgerservicenummer (BSN)</label><input id="registration_parents_attributes_bsnr_2" maxlength="9" name="registration[parents_attributes][bsnr_2]" size="9" type="text" /> </li> <li> <p class='inline-hints'>Als u hier geen adres invult, wordt automatisch het adres van ouder/verzorger 1 overgenomen.</p> </li> <li class="string input optional stringish" id="registration_parents_attributes_street_2_input"><label class=" label" for="registration_parents_attributes_street_2">Straat</label><input id="registration_parents_attributes_street_2" maxlength="60" name="registration[parents_attributes][street_2]" type="text" /> </li> <li class="string input optional stringish" id="registration_parents_attributes_number_2_input"><label class=" label" for="registration_parents_attributes_number_2">Huisnummer</label><input id="registration_parents_attributes_number_2" maxlength="10" name="registration[parents_attributes][number_2]" size="10" type="text" /> </li> <li class="string input optional stringish" id="registration_parents_attributes_extension_2_input"><label class=" label" for="registration_parents_attributes_extension_2">Huisnummertoevoeging</label><input id="registration_parents_attributes_extension_2" maxlength="10" name="registration[parents_attributes][extension_2]" size="10" type="text" /> </li> <li class="string input optional stringish" id="registration_parents_attributes_postcode_nrs_2_input"><label class=" label" for="registration_parents_attributes_postcode_nrs_2">Postcode (cijfers)</label><input id="registration_parents_attributes_postcode_nrs_2" maxlength="5" name="registration[parents_attributes][postcode_nrs_2]" type="text" /> </li> <li class="string input optional stringish" id="registration_parents_attributes_postcode_chars_2_input"><label class=" label" for="registration_parents_attributes_postcode_chars_2">Postcode (letters)</label><input id="registration_parents_attributes_postcode_chars_2" maxlength="2" name="registration[parents_attributes][postcode_chars_2]" size="2" style="text-transform: uppercase;" type="text" /> </li> <li class="string input optional stringish" id="registration_parents_attributes_city_2_input"><label class=" label" for="registration_parents_attributes_city_2">Woonplaats</label><input id="registration_parents_attributes_city_2" maxlength="60" name="registration[parents_attributes][city_2]" type="text" /> </li> <li class="string input optional stringish" id="registration_parents_attributes_phone_2_input"><label class=" label" for="registration_parents_attributes_phone_2">Telefoon (thuis)</label><input id="registration_parents_attributes_phone_2" maxlength="255" name="registration[parents_attributes][phone_2]" type="text" /> </li> <li class="string input optional stringish" id="registration_parents_attributes_mobile_2_input"><label class=" label" for="registration_parents_attributes_mobile_2">Mobiel</label><input id="registration_parents_attributes_mobile_2" maxlength="255" name="registration[parents_attributes][mobile_2]" type="text" /> </li> <li class="email input optional stringish" id="registration_parents_attributes_email_2_input"><label class=" label" for="registration_parents_attributes_email_2">Email</label><input id="registration_parents_attributes_email_2" maxlength="60" name="registration[parents_attributes][email_2]" size="20" type="email" /> </li> <li class="string input optional stringish" id="registration_parents_attributes_bic_code_2_input"><label class=" label" for="registration_parents_attributes_bic_code_2">BIC code</label><input id="registration_parents_attributes_bic_code_2" maxlength="255" name="registration[parents_attributes][bic_code_2]" type="text" /> </li> </ol></fieldset> </div> <div class='form_group' id='parent'> <h3 class='registration'>Noodpersoon</h3> <fieldset class="inputs"><ol> <li class="string input optional stringish" id="registration_emergency_person_attributes_firstname_input"><label class=" label" for="registration_emergency_person_attributes_firstname">Voornaam<abbr title="required">*</abbr></label><input id="registration_emergency_person_attributes_firstname" maxlength="60" name="registration[emergency_person_attributes][firstname]" type="text" /> </li> <li class="string input optional stringish" id="registration_emergency_person_attributes_in_between_first_and_lastname_input"><label class=" label" for="registration_emergency_person_attributes_in_between_first_and_lastname">Tussenvoegsel</label><input id="registration_emergency_person_attributes_in_between_first_and_lastname" maxlength="10" name="registration[emergency_person_attributes][in_between_first_and_lastname]" size="10" type="text" /> </li> <li class="string input optional stringish" id="registration_emergency_person_attributes_lastname_input"><label class=" label" for="registration_emergency_person_attributes_lastname">Achternaam<abbr title="required">*</abbr></label><input id="registration_emergency_person_attributes_lastname" maxlength="60" name="registration[emergency_person_attributes][lastname]" type="text" /> </li> <li class="select input required" id="registration_emergency_person_attributes_function_input"><label class=" label" for="registration_emergency_person_attributes_function">Relatie<abbr title="required">*</abbr></label><select id="registration_emergency_person_attributes_function" name="registration[emergency_person_attributes][function]"><option value=""></option> <option value="father">Vader</option> <option value="mother">Moeder</option> <option value="stepparent">Stiefouder</option> <option value="bonusparent">Bonusouder</option> <option value="caretakers">Noodpersonen</option> <option value="grandfather">Opa/oma</option> <option value="contactperson">Contactpersoon</option> <option value="other">Overig</option></select> </li> </ol></fieldset><fieldset class="inputs"><ol> <li class="string input optional stringish" id="registration_emergency_person_attributes_phone_input"><label class=" label" for="registration_emergency_person_attributes_phone">Telefoon (thuis)</label><input id="registration_emergency_person_attributes_phone" maxlength="255" name="registration[emergency_person_attributes][phone]" type="text" /> </li> <li class="string input required stringish" id="registration_emergency_person_attributes_mobile_input"><label class=" label" for="registration_emergency_person_attributes_mobile">Mobiel<abbr title="required">*</abbr></label><input id="registration_emergency_person_attributes_mobile" maxlength="255" name="registration[emergency_person_attributes][mobile]" type="text" /> </li> </ol></fieldset> </div> <div class='clear'></div> <div class='form_group' id='parent'> <fieldset class="actions" id="registration_buttons"><ol><input id="accept_privacy_statement" name="accept_privacy_statement" onclick="toggle_on_accept()" type="checkbox" value="1" /> Ik ga akkoord met het <a href="https://kdvnet3.s3.amazonaws.com/uploads/a133b41e-23a8-4e04-b682-d6ff25649cfc/Privacy_Statement_kinderopvang_Flekss.pdf">Privacy Statement</a> <li class="action input_action " id="registration_submit_action"><input id="form-submit-button" name="commit" type="submit" value="Aanmelding verzenden" /></li> </ol></fieldset></div> </form> </div> <script> $(document).on('click', '.language-link', function(e) { e.preventDefault(); window.location.href = $(this).attr('href'); }); $("form#new_registration").submit(function() { var answers = []; $('.consent-required').each(function(){ var consentAnswer = $(this).val(); answers.push(consentAnswer); }); if (answers.includes('')){ alert('Selecteer Ja of Nee voor elke verplichte Toestemmingsvraag (met *).'); return false; } else { $('#form-submit-button').prop("disabled", true); } }); // function showRegistrationBicCode(){ // if ($('select#registration_parents_attributes_country_1').val() == "Nederland"){ // $('li#registration_parents_attributes_bic_code_1_input').hide() // } else { // $('li#registration_parents_attributes_bic_code_1_input').show() // }; // if ($('select#registration_parents_attributes_country_2').val() == "Nederland"){ // $('li#registration_parents_attributes_bic_code_2_input').hide() // } else { // $('li#registration_parents_attributes_bic_code_2_input').show() // }; // }; function toggle_jointly_income(value){ if (value == 'U woont samen en één partner is niet werkzaam' || value == 'U woont samen en beide partners zijn niet werkzaam' || value == 'U bent alleen en niet werkzaam'){ $('li#registration_parents_attributes_jointly_income_input').show(); } else { $('li#registration_parents_attributes_jointly_income_input').hide(); } }; function toggle_on_accept(){ if (document.getElementById('accept_privacy_statement').checked){ $(':input[type="submit"]').prop('disabled', false); } else { $(':input[type="submit"]').prop('disabled', true); } }; toggle_on_accept(); $(document).ready(function() { $('#registration_child_attributes_date_of_birth').datepicker({yearRange: '1930:2050', firstDay: 1}); $('#registration_parents_attributes_date_of_birth_1').datepicker({yearRange: '1930:2050', firstDay: 1}); $('#registration_parents_attributes_date_of_birth_2').datepicker({yearRange: '1930:2050', firstDay: 1}); $('#registration_emergency_person_attributes_date_of_birth').datepicker({yearRange: '1930:2050', firstDay: 1}); $('#registration_preferred_start_date').datepicker({yearRange: '1930:2050', firstDay: 1}); $('#registration_preferred_end_date').datepicker({yearRange: '1930:2050', firstDay: 1}); function clearDateErrors(fieldId) { var dateField = $(fieldId); dateField.css('border-color', ''); dateField.siblings('.inline-errors').remove(); } function disableChildFields() { $('input#registration_child_attributes_bsnr').attr('disabled', 'disabled').val(''); $('select#registration_child_attributes_class_room_id').attr('disabled', 'disabled').val(''); $('textarea#registration_child_attributes_vaccination_notes').attr('disabled', 'disabled').val(''); $('select#registration_child_attributes\\[homeland\\]').attr('disabled', 'disabled').val(''); $('input#registration_child_attributes_nationality').attr('disabled', 'disabled').val(''); } function enableChildFields() { $('input#registration_child_attributes_bsnr').removeAttr('disabled'); $('textarea#registration_child_attributes_vaccination_notes').removeAttr('disabled'); $('select#registration_child_attributes_class_room_id').removeAttr('disabled'); $('select#registration_child_attributes\\[homeland\\]').removeAttr('disabled'); $('input#registration_child_attributes_nationality').removeAttr('disabled'); } function parseDate(dateString) { if (!dateString) return null; var parts = dateString.split('-'); if (parts.length !== 3) return null; var day = parseInt(parts[0], 10); var month = parseInt(parts[1], 10); var year = parseInt(parts[2], 10); if (isNaN(day) || isNaN(month) || isNaN(year)) return null; if (day < 1 || day > 31 || month < 1 || month > 12) return null; var date = new Date(year, month - 1, day); date.setHours(0, 0, 0, 0); if (isNaN(date.getTime())) return null; if (date.getDate() !== day || date.getMonth() !== (month - 1) || date.getFullYear() !== year) return null; return date; } function isFutureDate(dateString) { var date = parseDate(dateString); if (!date) return false; var today = new Date(); today.setHours(0, 0, 0, 0); return date > today; } function isPastDate(dateString) { var date = parseDate(dateString); if (!date) return false; var today = new Date(); today.setHours(0, 0, 0, 0); return date < today; } function isValidDateRange(dateString, minYear, maxYear) { var date = parseDate(dateString); if (!date) return false; return date.getFullYear() >= minYear && date.getFullYear() <= maxYear; } function showDateError(fieldId, errorMessage) { var dateField = $(fieldId); dateField.css('border-color', '#cc0000'); if (!dateField.siblings('.inline-errors').length) { dateField.after('<p class="inline-errors" style="font-size: 0.875em; margin-top: 0.25rem;">' + errorMessage + '</p>'); } } function validateDateField(fieldId, errorMessage, allowFuture = false, allowPast = true, minYear = null, maxYear = null) { var dateField = $(fieldId); var dateValue = dateField.val(); if (dateValue) { var parsedDate = parseDate(dateValue); if (!parsedDate) { showDateError(fieldId, "Voer een geldige datum in"); return false; } if (minYear && maxYear && !isValidDateRange(dateValue, minYear, maxYear)) { var errorMessage = "Datum moet tussen %{min_year} en %{max_year} liggen".replace('%{min_year}', minYear).replace('%{max_year}', maxYear); showDateError(fieldId, errorMessage); return false; } if (!allowFuture && isFutureDate(dateValue)) { showDateError(fieldId, errorMessage); return false; } if (!allowPast && isPastDate(dateValue)) { showDateError(fieldId, errorMessage); return false; } } clearDateErrors(fieldId); return true; } if ($('input#registration_child_attributes_disable_bsnr').prop('checked')) { disableChildFields(); } $('input#registration_child_attributes_disable_bsnr').bind('change', function(){ var birthDateValue = $('#registration_child_attributes_date_of_birth').val(); if (!$(this).prop('checked') && isFutureDate(birthDateValue)) { $(this).prop('checked', true); return; } if ($(this).prop('checked')) { disableChildFields(); validateBirthDate(); } else { enableChildFields(); clearDateErrors('#registration_child_attributes_date_of_birth'); } }); // show or hide select input jointly income when rerendered form in case of a validation error var personalSituationSelect = $('select#registration_parents_attributes_personal_situation')[0]; if (personalSituationSelect) { toggle_jointly_income(personalSituationSelect.value); }; $('select#registration_parents_attributes_personal_situation').bind('change', function(){ toggle_jointly_income(this.value); }); function validateBirthDate() { var birthDateField = $('#registration_child_attributes_date_of_birth'); var birthDateValue = birthDateField.val(); var disableBsnrCheckbox = $('input#registration_child_attributes_disable_bsnr'); if (birthDateValue) { var parsedDate = parseDate(birthDateValue); if (!parsedDate) { showDateError('#registration_child_attributes_date_of_birth', "Voer een geldige datum in"); return; } var currentYear = new Date().getFullYear(); var minChildYear = currentYear - 20; var maxChildYear = currentYear + 2; if (!isValidDateRange(birthDateValue, minChildYear, maxChildYear)) { var errorMessage = "Datum moet tussen %{min_year} en %{max_year} liggen".replace('%{min_year}', minChildYear).replace('%{max_year}', maxChildYear); showDateError('#registration_child_attributes_date_of_birth', errorMessage); return; } if (isFutureDate(birthDateValue)) { disableBsnrCheckbox.prop('checked', true); disableBsnrCheckbox.data('auto-checked', true); disableChildFields(); } else if (isPastDate(birthDateValue)) { if (disableBsnrCheckbox.data('auto-checked')) { disableBsnrCheckbox.prop('checked', false); enableChildFields(); disableBsnrCheckbox.data('auto-checked', false); return; } } if (disableBsnrCheckbox.prop('checked') && isPastDate(birthDateValue)) { showDateError('#registration_child_attributes_date_of_birth', "Geboortedatum kan niet in het verleden liggen wanneer 'Geschatte geboortedatum' is aangevinkt"); return; } } } $('#registration_child_attributes_date_of_birth').bind('change', function(){ clearDateErrors('#registration_child_attributes_date_of_birth'); validateBirthDate(); }); var $parent2_not_applicable = $('input#parent2_not_applicable'); var $parent2_fieldset = $('#parent2 fieldset'); $parent2_fieldset.toggle(!$parent2_not_applicable.is(':checked')); $parent2_not_applicable.on('change', function() { $parent2_fieldset.toggle(!this.checked); }); $('#registration_parents_attributes_date_of_birth_1').bind('change', function(){ var currentYear = new Date().getFullYear(); var minParentYear = currentYear - 100; var maxParentYear = currentYear - 15; validateDateField( '#registration_parents_attributes_date_of_birth_1', "Geboortedatum kan niet in de toekomst liggen", false, true, minParentYear, maxParentYear ); }); $('#registration_parents_attributes_date_of_birth_2').bind('change', function(){ var currentYear = new Date().getFullYear(); var minParentYear = currentYear - 100; var maxParentYear = currentYear - 15; validateDateField( '#registration_parents_attributes_date_of_birth_2', "Geboortedatum kan niet in de toekomst liggen", false, true, minParentYear, maxParentYear ); }); $('#registration_emergency_person_attributes_date_of_birth').bind('change', function(){ var currentYear = new Date().getFullYear(); var minEmergencyYear = currentYear - 100; var maxEmergencyYear = currentYear - 15; validateDateField( '#registration_emergency_person_attributes_date_of_birth', "Geboortedatum kan niet in de toekomst liggen", false, true, minEmergencyYear, maxEmergencyYear ); }); $('#registration_preferred_start_date').bind('change', function(){ var currentYear = new Date().getFullYear(); var minStartYear = currentYear - 1; var maxStartYear = currentYear + 5; validateDateField( '#registration_preferred_start_date', "Startdatum kan niet in het verleden liggen", true, false, minStartYear, maxStartYear ); }); $('#registration_preferred_end_date').bind('change', function(){ var endDateField = $('#registration_preferred_end_date'); var startDateField = $('#registration_preferred_start_date'); var endDateValue = endDateField.val(); var startDateValue = startDateField.val(); var currentYear = new Date().getFullYear(); var minEndYear = currentYear; var maxEndYear = currentYear + 20; clearDateErrors('#registration_preferred_end_date'); if (endDateValue) { var parsedEndDate = parseDate(endDateValue); if (!parsedEndDate) { showDateError('#registration_preferred_end_date', "Voer een geldige datum in"); return; } if (!isValidDateRange(endDateValue, minEndYear, maxEndYear)) { var errorMessage = "Datum moet tussen %{min_year} en %{max_year} liggen".replace('%{min_year}', minEndYear).replace('%{max_year}', maxEndYear); showDateError('#registration_preferred_end_date', errorMessage); return; } if (isPastDate(endDateValue)) { showDateError('#registration_preferred_end_date', "Einddatum kan niet in het verleden liggen"); return; } if (startDateValue && parseDate(endDateValue) <= parseDate(startDateValue)) { showDateError('#registration_preferred_end_date', "Einddatum moet na startdatum liggen"); return; } } }); $('#registration_preferred_start_date').bind('change', function(){ var endDateField = $('#registration_preferred_end_date'); if (endDateField.val()) { endDateField.trigger('change'); } }); }); document.addEventListener("DOMContentLoaded", function() { function updateBIC(ibanInputId, bicInputId) { const ibanField = document.getElementById(ibanInputId); const bicField = document.getElementById(bicInputId); if (!ibanField || !bicField) { console.error(`Element not found: ${ibanInputId} or ${bicInputId}`); return; } ibanField.addEventListener('input', function() { var iban = ibanField.value.trim(); if (iban.length >= 8) { // Only lookup if IBAN is long enough fetch('/bic_codes/lookup?iban=' + encodeURIComponent(iban)) .then(function(response) { return response.json(); }) .then(function(data) { bicField.value = data.bic || ''; }) .catch(function(error) { console.error("Error fetching BIC:", error); bicField.value = ''; }); } else { bicField.value = ''; } }); } updateBIC('registration_parents_attributes_iban_1', 'registration_parents_attributes_bic_code_1'); }); </script> </div> </body> </html>