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} .formtastic button{ font-family: sans-serif; font-size: inherit; font-weight: inherit; height: 24px; } .formtastic input[type='submit']{ height: 24px; } .logo { background-image: url(https://kdvnet3.s3.amazonaws.com/uploads/71e405cd-fda8-4eb0-9536-64a5942a4ee6/logo-miracle-kids2.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> <div id='new_child_form'> <h2>Aanmelding voor BSO Miracle Kids</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="SdsICcTQem26RDyHRry59Nlk9DWhs76IetZQ+HUqh7o=" /></div><input id="registration_token" name="registration_token" type="hidden" value="1K0mxazWoCImE8j6cSPm" /> <div class='form_group' id='parent'> <h3 class='registration'>Toelichting</h3> <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> </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 optional stringish" id="registration_child_attributes_emergency_phone_input"><label class=" label" for="registration_child_attributes_emergency_phone">Telefoon (bij nood)</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="string input optional stringish" id="registration_child_attributes_language_input"><label class=" label" for="registration_child_attributes_language">Spreektaal</label><input id="registration_child_attributes_language" maxlength="255" name="registration[child_attributes][language]" type="text" /> </li> <li class="select input optional" id="registration_child_attributes_gender_input"><label class=" label" for="registration_child_attributes_gender">Geslacht</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">Burgerservicenr<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 optional stringish" id="registration_child_attributes_nickname_input"><label class=" label" for="registration_child_attributes_nickname">Roepnaam</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="170332">7e Montessorischool - Amsterdam - M3 - </option> <option value="164836">7e Montessorischool - Amsterdam - M4 - Anne en Havana en Laetitia</option> <option value="170331">7e Montessorischool - Amsterdam - M5 - </option> <option value="166533">7e Montessorischool - Amsterdam - M6 - Linda Frederieke</option> <option value="171366">7e Montessorischool - Amsterdam - O2 - </option> <option value="164837">7e Montessorischool - Amsterdam - O3 - Manon en Els</option> <option value="164835">7e Montessorischool - Amsterdam - O5 - Ursula en Lisette</option> <option value="165878">Al Wafa 1 en 2 - Amsterdam - 6 - </option> <option value="166634">Al Wafa 3 tm 8 - Amsterdam - 6-A - Aminah en Samya</option> <option value="164844">BS Fiep Westendorp - Amsterdam - 1/2B - Alessa en Latifa</option> <option value="164843">BS Fiep Westendorp - Amsterdam - 1/2C - Annet en Aicha</option> <option value="165985">Burgemeester de Vlugtschool - Amsterdam - 2D - juf Esin en Karim</option> <option value="165984">Burgemeester de Vlugtschool - Amsterdam - 4A - juf Floor en Anke</option> <option value="165713">DENISE De Nieuwe Internationale School Esprit - Amsterdam - 1/2A - Stefan Elevelt</option> <option value="165697">DENISE De Nieuwe Internationale School Esprit - Amsterdam - 1/2B - Katelijne O’Shea en Jolien van der Kamp-Gielleit</option> <option value="165714">DENISE De Nieuwe Internationale School Esprit - Amsterdam - 1/2C - Rianne Stern en Amaya Fernandez</option> <option value="165318">DENISE De Nieuwe Internationale School Esprit - Amsterdam - 1/2D - Saskia Nivard en Amaya Fernandez</option> <option value="164670">DENISE De Nieuwe Internationale School Esprit - Amsterdam - 1/2D - Saskia en Amaya</option> <option value="165715">DENISE De Nieuwe Internationale School Esprit - Amsterdam - 3A - Imara Mud en Chantelle Tucker</option> <option value="165716">DENISE De Nieuwe Internationale School Esprit - Amsterdam - 3B - Laurien Kramer en Chantelle Tucker</option> <option value="164671">DENISE De Nieuwe Internationale School Esprit - Amsterdam - 4A - Pamela</option> <option value="165717">DENISE De Nieuwe Internationale School Esprit - Amsterdam - 4A - Willemijn Bekebrede en Patricia Ubago</option> <option value="164672">DENISE De Nieuwe Internationale School Esprit - Amsterdam - 4B - Pamela Baas en Patricia Ubago</option> <option value="166351">DENISE De Nieuwe Internationale School Esprit - Amsterdam - 4D - </option> <option value="165718">DENISE De Nieuwe Internationale School Esprit - Amsterdam - 5A - Marije Schrier en Terri Prinsloo</option> <option value="165712">DENISE De Nieuwe Internationale School Esprit - Amsterdam - 5B - Dagmar Kloppenburg en Kaisa Eskelinen</option> <option value="165719">DENISE De Nieuwe Internationale School Esprit - Amsterdam - 6 - Elisa Mons</option> <option value="165720">DENISE De Nieuwe Internationale School Esprit - Amsterdam - 7 - Jordy Smeekens en Katya Barrins</option> <option value="165721">DENISE De Nieuwe Internationale School Esprit - Amsterdam - 8 - Dominique Beurskens en Maria Boukoura</option> <option value="168468">De Toekomst - Amsterdam - 1/2 A - Witteke en juf Amal</option> <option value="164847">De Toekomst - Amsterdam - 1/2B - Fedoua en Lamyaa</option> <option value="167853">De Toekomst - Amsterdam - 1/2 C - juf Lia</option> <option value="165699">De Toekomst - Amsterdam - 3 - Juf Iris en juf Malika</option> <option value="164846">De Toekomst - Amsterdam - 4 - Lieke en Zehra</option> <option value="166311">De Toekomst - Amsterdam - 5 - Juf Lindsey - Juf Esra</option> <option value="164845">De Toekomst - Amsterdam - 6 - Maties</option> <option value="164849">Huibersschool - Amsterdam - 7 - Natasha</option> <option value="165251">Huizingaschool - Amsterdam - 1/2B - juf Jaimy</option> <option value="170859">Huizingaschool - Amsterdam - 1/2B - </option> <option value="164850">Huizingaschool - Amsterdam - 1/2C - Charlotte</option> <option value="165956">IBS El Amien 2 - Amsterdam - 1/2A - Juf Rukiye en Imane</option> <option value="165988">IBS El Amien 2 - Amsterdam - 1/2 C - juf Farida</option> <option value="165954">IBS El Amien 2 - Amsterdam - 5A - juf Emine</option> <option value="165955">IBS El Amien 2 - Amsterdam - 7B - meester Özkan</option> <option value="165707">IBS El Kadisia - Amsterdam - 1/2 - juf Denice en Jamila </option> <option value="165694">IBS El Kadisia - Amsterdam - 1/2A - juf Louiza en juf mariam</option> <option value="165953">IBS El Kadisia - Amsterdam - 1/2 B - Esther en Saadia</option> <option value="171406">IBS El Kadisia - Amsterdam - 1/2D - juf emine en joyslyn</option> <option value="164834">IBS El Kadisia - Amsterdam - 1/2 F - Anoeska</option> <option value="165695">IBS El Kadisia - Amsterdam - 3 - juf Selma en Suzan</option> <option value="164833">IBS El Kadisia - Amsterdam - 3A - Souad</option> <option value="165696">IBS El Kadisia - Amsterdam - 3A - Souad</option> <option value="165708">IBS El Kadisia - Amsterdam - 4A - Juf Wafa en Hava</option> <option value="170857">IBS El Kadisia - Amsterdam - 5C - Juf Karima en Najat</option> <option value="167147">IBS El Kadisia - Amsterdam - 6B - juf Ibtissame</option> <option value="164855">Ichthusschool - Amsterdam - 1/2B - Marga</option> <option value="164852">Ichthusschool - Amsterdam - 1/2D - Joan</option> <option value="164854">Ichthusschool - Amsterdam - 2/3F - Janine</option> <option value="164853">Ichthusschool - Amsterdam - 4B - Esmee</option> <option value="164851">Ichthusschool - Amsterdam - 7A - Iris</option> <option value="170270">ouder brengt zelf - Amsterdam - 116 - </option> <option value="165209">Pro Regeschool Hemsterhuis - Amsterdam - 1/2A - juf Noelle en Heleen</option> <option value="166744">Pro Regeschool Hemsterhuis - Amsterdam - 3C - juf Farah</option> <option value="165210">Pro Regeschool Hemsterhuis - Amsterdam - 5C - juf Annemarieke en juf Jane </option> <option value="166743">Pro Regeschool Hemsterhuis - Amsterdam - 6C - Meester Aldo en Niels</option> <option value="171367">SBO de Hasselbraam - Amsterdam - 1A - juf Marieke</option> <option value="170860">SBO de Hasselbraam - Amsterdam - 1B - </option> <option value="170856">SBO de Hasselbraam - Amsterdam - 1C - </option> <option value="166352">SBO de Hasselbraam - Amsterdam - 2A - Lisa</option> <option value="165693">SBO de Hasselbraam - Amsterdam - 2B - juf Anouk en Evelien</option> <option value="170515">SBO de Hasselbraam - Amsterdam - 2D - </option> <option value="170333">SBO de Hasselbraam - Amsterdam - 3B - </option> <option value="164859">SBO de Hasselbraam - Amsterdam - 3C - Sofia, Pirette, Max, Suleyman</option> <option value="165698">SBO de Hasselbraam - Amsterdam - 3D - juf Jolijn</option> <option value="171996">Signis Kentalis - Amsterdam - 4A - </option></select> </li> <li class="text input optional" id="registration_child_attributes_allergy_notes_input"><label class=" label" for="registration_child_attributes_allergy_notes">Allergie</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="text input optional" id="registration_child_attributes_vaccination_notes_input"><label class=" label" for="registration_child_attributes_vaccination_notes">Inentingen</label><textarea id="registration_child_attributes_vaccination_notes" name="registration[child_attributes][vaccination_notes]" rows="20"> </textarea> </li> <li class="string input optional stringish" id="registration_child_attributes_health_insurance_input"><label class=" label" for="registration_child_attributes_health_insurance">Zorgverzekering</label><input id="registration_child_attributes_health_insurance" maxlength="60" name="registration[child_attributes][health_insurance]" type="text" /> </li> <li class="string input optional stringish" id="registration_child_attributes_health_insurance_policy_number_input"><label class=" label" for="registration_child_attributes_health_insurance_policy_number">Polisnummer</label><input id="registration_child_attributes_health_insurance_policy_number" maxlength="60" name="registration[child_attributes][health_insurance_policy_number]" type="text" /> </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> </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_4297_input"><label class=" label" for="registration_consent_4297">Foto's op social media<abbr title="required">*</abbr></label><select class="consent-required" id="registration_consent_4297" name="registration[consent][4297]"><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_5133_input"><label class=" label" for="registration_consent_5133">Informatie delen met de school van uw kind<abbr title="required">*</abbr></label><select class="consent-required" id="registration_consent_5133" name="registration[consent][5133]"><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_7548_input"><label class=" label" for="registration_consent_7548">Mag de leidster met uw kind naar de huisarts bij een ongeval?<abbr title="required">*</abbr></label><select class="consent-required" id="registration_consent_7548" name="registration[consent][7548]"><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 optional stringish" id="registration_parents_attributes_title_1_input"><label class=" label" for="registration_parents_attributes_title_1">Aanhef</label><input id="registration_parents_attributes_title_1" maxlength="10" name="registration[parents_attributes][title_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 required" id="registration_parents_attributes_function_1_input"><label class=" label" for="registration_parents_attributes_function_1">Relatie<abbr title="required">*</abbr></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">Verzorger</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 optional stringish" id="registration_parents_attributes_language_1_input"><label class=" label" for="registration_parents_attributes_language_1">Spreektaal</label><input id="registration_parents_attributes_language_1" maxlength="255" name="registration[parents_attributes][language_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">Burgerservicenr<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 optional stringish" id="registration_parents_attributes_education_level_1_input"><label class=" label" for="registration_parents_attributes_education_level_1">Hoogst genoten opleiding</label><input id="registration_parents_attributes_education_level_1" maxlength="60" name="registration[parents_attributes][education_level_1]" type="text" /> </li> <li class="string input required stringish" id="registration_parents_attributes_profession_1_input"><label class=" label" for="registration_parents_attributes_profession_1">Beroep<abbr title="required">*</abbr></label><input id="registration_parents_attributes_profession_1" maxlength="255" name="registration[parents_attributes][profession_1]" 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 required stringish" id="registration_parents_attributes_extension_1_input"><label class=" label" for="registration_parents_attributes_extension_1">Huisnummertoevoeging<abbr title="required">*</abbr></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 nr<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 (ltrs)<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 optional stringish" id="registration_parents_attributes_city_1_input"><label class=" label" for="registration_parents_attributes_city_1">Woonplaats</label><input id="registration_parents_attributes_city_1" maxlength="60" name="registration[parents_attributes][city_1]" type="text" /> </li> <li class="select input optional" id="registration_parents_attributes_country_1_input"><label class=" label" for="registration_parents_attributes_country_1">Land</label><select id="registration_parents_attributes_country_1" name="registration[parents_attributes][country_1]"><option value="Nederland" selected="selected">Nederland</option> <option value="België">België</option> <option value="Duitsland">Duitsland</option> <option value="Land Onbekend">Land Onbekend</option></select> </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">Telefoon (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="string input optional stringish" id="registration_parents_attributes_work_phone_1_input"><label class=" label" for="registration_parents_attributes_work_phone_1">Telefoon (werk)</label><input id="registration_parents_attributes_work_phone_1" maxlength="255" name="registration[parents_attributes][work_phone_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 optional stringish" id="registration_parents_attributes_iban_1_input"><label class=" label" for="registration_parents_attributes_iban_1">IBAN nummer</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='parent'> <h3 class='registration'>Ouder/verzorger 2</h3> <fieldset class="inputs"><ol><li class="string input optional stringish" id="registration_parents_attributes_title_2_input"><label class=" label" for="registration_parents_attributes_title_2">Aanhef</label><input id="registration_parents_attributes_title_2" maxlength="10" name="registration[parents_attributes][title_2]" size="10" type="text" /> </li> <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="select input optional" id="registration_parents_attributes_function_2_input"><label class=" label" for="registration_parents_attributes_function_2">Relatie</label><select id="registration_parents_attributes_function_2" name="registration[parents_attributes][function_2]"><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">Verzorger</option> <option value="grandfather">Opa/oma</option> <option value="contactperson">Contactpersoon</option> <option value="other">Overig</option></select> </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_language_2_input"><label class=" label" for="registration_parents_attributes_language_2">Spreektaal</label><input id="registration_parents_attributes_language_2" maxlength="255" name="registration[parents_attributes][language_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">Burgerservicenr</label><input id="registration_parents_attributes_bsnr_2" maxlength="9" name="registration[parents_attributes][bsnr_2]" size="9" type="text" /> </li> <li class="string input optional stringish" id="registration_parents_attributes_education_level_2_input"><label class=" label" for="registration_parents_attributes_education_level_2">Hoogst genoten opleiding</label><input id="registration_parents_attributes_education_level_2" maxlength="60" name="registration[parents_attributes][education_level_2]" type="text" /> </li> <li class="string input required stringish" id="registration_parents_attributes_profession_2_input"><label class=" label" for="registration_parents_attributes_profession_2">Beroep<abbr title="required">*</abbr></label><input id="registration_parents_attributes_profession_2" maxlength="255" name="registration[parents_attributes][profession_2]" 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 nr</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 (ltrs)</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="select input optional" id="registration_parents_attributes_country_2_input"><label class=" label" for="registration_parents_attributes_country_2">Land</label><select id="registration_parents_attributes_country_2" name="registration[parents_attributes][country_2]"><option value="Nederland" selected="selected">Nederland</option> <option value="België">België</option> <option value="Duitsland">Duitsland</option> <option value="Land Onbekend">Land Onbekend</option></select> </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">Telefoon (mobiel)</label><input id="registration_parents_attributes_mobile_2" maxlength="255" name="registration[parents_attributes][mobile_2]" type="text" /> </li> <li class="string input optional stringish" id="registration_parents_attributes_work_phone_2_input"><label class=" label" for="registration_parents_attributes_work_phone_2">Telefoon (werk)</label><input id="registration_parents_attributes_work_phone_2" maxlength="255" name="registration[parents_attributes][work_phone_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_title_input"><label class=" label" for="registration_emergency_person_attributes_title">Aanhef</label><input id="registration_emergency_person_attributes_title" maxlength="255" name="registration[emergency_person_attributes][title]" size="10" type="text" /> </li> <li class="string input optional stringish" id="registration_emergency_person_attributes_initials_input"><label class=" label" for="registration_emergency_person_attributes_initials">Initialen</label><input id="registration_emergency_person_attributes_initials" maxlength="10" name="registration[emergency_person_attributes][initials]" size="10" type="text" /> </li> <li class="string input optional stringish" id="registration_emergency_person_attributes_firstname_input"><label class=" label" for="registration_emergency_person_attributes_firstname">Voornaam</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</label><input id="registration_emergency_person_attributes_lastname" maxlength="60" name="registration[emergency_person_attributes][lastname]" type="text" /> </li> <li class="select input optional" id="registration_emergency_person_attributes_function_input"><label class=" label" for="registration_emergency_person_attributes_function">Relatie</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">Verzorger</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_city_input"><label class=" label" for="registration_emergency_person_attributes_city">Woonplaats</label><input id="registration_emergency_person_attributes_city" maxlength="60" name="registration[emergency_person_attributes][city]" type="text" /> </li> <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 optional stringish" id="registration_emergency_person_attributes_mobile_input"><label class=" label" for="registration_emergency_person_attributes_mobile">Telefoon (mobiel)</label><input id="registration_emergency_person_attributes_mobile" maxlength="255" name="registration[emergency_person_attributes][mobile]" type="text" /> </li> <li class="string input optional stringish" id="registration_emergency_person_attributes_work_phone_input"><label class=" label" for="registration_emergency_person_attributes_work_phone">Telefoon (werk)</label><input id="registration_emergency_person_attributes_work_phone" maxlength="255" name="registration[emergency_person_attributes][work_phone]" type="text" /> </li> <li class="email input optional stringish" id="registration_emergency_person_attributes_email_input"><label class=" label" for="registration_emergency_person_attributes_email">Email</label><input id="registration_emergency_person_attributes_email" maxlength="60" name="registration[emergency_person_attributes][email]" size="20" type="email" /> </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/c02f62a2-a676-473d-bf11-45d81b1cc31d/privacyverklaring_mirace-kids.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> $( "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}); showRegistrationBicCode(); $('select#registration_parents_attributes_country_1').bind('change', function(){ showRegistrationBicCode() }); $('select#registration_parents_attributes_country_2').bind('change', function(){ showRegistrationBicCode() }); if( $('input#registration_child_attributes_disable_bsnr').prop('checked')){ $('input#registration_child_attributes_bsnr').attr('disabled', 'disabled'); $('input#registration_child_attributes_bsnr').val(''); $('select#registration_child_attributes_class_room_id').attr('disabled', 'disabled'); $('select#registration_child_attributes_class_room_id').val(''); $('textarea#registration_child_attributes_vaccination_notes').attr('disabled', 'disabled'); $('textarea#registration_child_attributes_vaccination_notes').val(''); }; $('input#registration_child_attributes_disable_bsnr').bind('change', function(){ if( $('input#registration_child_attributes_disable_bsnr').prop('checked')){ $('input#registration_child_attributes_bsnr').attr('disabled', 'disabled'); $('input#registration_child_attributes_bsnr').val(''); $('select#registration_child_attributes_class_room_id').attr('disabled', 'disabled'); $('select#registration_child_attributes_class_room_id').val(''); $('textarea#registration_child_attributes_vaccination_notes').attr('disabled', 'disabled'); $('textarea#registration_child_attributes_vaccination_notes').val(''); }else{ $('input#registration_child_attributes_bsnr').removeAttr('disabled'); $('textarea#registration_child_attributes_vaccination_notes').removeAttr('disabled'); $('select#registration_child_attributes_class_room_id').removeAttr('disabled'); }; }); // 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); }); }); </script> </div> </body> </html>