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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 De Maneblussertjes - BSO de Goede Polder</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="Ih5ECtm9gqtp5l7IMv5lozbCHHWH/RZf7gHilkmrSzo=" /></div><input id="registration_token" name="registration_token" type="hidden" value="mRkiSkeqXOFBI-6Ip7dY" /> <div class='form_group' id='parent'> <h3 class='registration'>Toelichting</h3> <h4><p>U kunt kiezen voor een 40 weken contract of een 52 weken contract.</p> <p>Wanneer u een 52 weken contract wilt afnemen kruist u eerst de benodigde dagen aan en kruist u vervolgens dezelfde dagen aan bij "dagen inclusief vakantie"</p> <p>De vakantieopvang word aangeboden op één van onze grotere buitenschoolse opvang locaties in middelburg.</p> <p>We bieden naschoolse opvang aan op dinsdag en donderdag.</p> <p>We bieden vakantieopvang aan op maandag, dinsdag donderdag en vrijdag.</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 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="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 optional stringish" id="registration_child_attributes_date_of_birth_input"><label class=" label" for="registration_child_attributes_date_of_birth">Geboortedatum</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="-">nog onbekend</option></select> </li> <li class="string input optional stringish" id="registration_child_attributes_bsnr_input"><label class=" label" for="registration_child_attributes_bsnr">Burgerservicenr</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="163339">De Goede Polder - Vrouwenpolder - Groep ? - </option> <option value="163268">De Goede Polder - Vrouwenpolder - Groep 1 - </option> <option value="163269">De Goede Polder - Vrouwenpolder - Groep 2 - </option> <option value="163270">De Goede Polder - Vrouwenpolder - Groep 3 - </option> <option value="163271">De Goede Polder - Vrouwenpolder - Groep 4 - </option> <option value="163272">De Goede Polder - Vrouwenpolder - Groep 5 - </option> <option value="163273">De Goede Polder - Vrouwenpolder - Groep 6 - </option> <option value="163274">De Goede Polder - Vrouwenpolder - Groep 7 - </option> <option value="163275">De Goede Polder - Vrouwenpolder - Groep 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">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">Medicijnen</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_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> </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 optional" id="registration_consent_3277_input"><label class=" label" for="registration_consent_3277">Ik geef toestemming voor het verlaten van de BSO bij buitenactiviteiten</label><select class="" id="registration_consent_3277" name="registration[consent][3277]"><option value=""></option> <option value="Ja">Ja</option> <option value="Nee">Nee</option></select> </li> </li> <li> <li class="select input optional" id="registration_consent_3278_input"><label class=" label" for="registration_consent_3278">Ik geef toestemming voor het versturen van foto's in de digitale schriftjes van mij en andere ouders</label><select class="" id="registration_consent_3278" name="registration[consent][3278]"><option value=""></option> <option value="Ja">Ja</option> <option value="Nee">Nee</option></select> </li> </li> <li> <li class="select input optional" id="registration_consent_3279_input"><label class=" label" for="registration_consent_3279">Ik geef toestemming om gebruik te maken van foto’s voor de website</label><select class="" id="registration_consent_3279" name="registration[consent][3279]"><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 optional stringish" id="registration_parents_attributes_initials_1_input"><label class=" label" for="registration_parents_attributes_initials_1">Initialen</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 optional stringish" id="registration_parents_attributes_firstname_1_input"><label class=" label" for="registration_parents_attributes_firstname_1">Voornaam</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="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_1_input"><label class=" label" for="registration_parents_attributes_date_of_birth_1">Geboortedatum</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 optional stringish" id="registration_parents_attributes_bsnr_1_input"><label class=" label" for="registration_parents_attributes_bsnr_1">Burgerservicenr</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 optional stringish" id="registration_parents_attributes_street_1_input"><label class=" label" for="registration_parents_attributes_street_1">Straat</label><input id="registration_parents_attributes_street_1" maxlength="60" name="registration[parents_attributes][street_1]" type="text" /> </li> <li class="string input optional stringish" id="registration_parents_attributes_number_1_input"><label class=" label" for="registration_parents_attributes_number_1">Huisnummer</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 optional stringish" id="registration_parents_attributes_postcode_nrs_1_input"><label class=" label" for="registration_parents_attributes_postcode_nrs_1">Postcode nr</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 optional stringish" id="registration_parents_attributes_postcode_chars_1_input"><label class=" label" for="registration_parents_attributes_postcode_chars_1">Postcode (ltrs)</label><input id="registration_parents_attributes_postcode_chars_1" maxlength="2" name="registration[parents_attributes][postcode_chars_1]" size="2" 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></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 optional stringish" id="registration_parents_attributes_mobile_1_input"><label class=" label" for="registration_parents_attributes_mobile_1">Telefoon (mobiel)</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="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> <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" 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></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="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_emergency_person_attributes_date_of_birth_input"><label class=" label" for="registration_emergency_person_attributes_date_of_birth">Geboortedatum</label><input id="registration_emergency_person_attributes_date_of_birth" name="registration[emergency_person_attributes][date_of_birth]" type="text" /> </li> <li class="string input optional stringish" id="registration_emergency_person_attributes_bsnr_input"><label class=" label" for="registration_emergency_person_attributes_bsnr">Burgerservicenr</label><input id="registration_emergency_person_attributes_bsnr" maxlength="9" name="registration[emergency_person_attributes][bsnr]" size="9" type="text" /> </li> </ol></fieldset><fieldset class="inputs"><ol><li class="string input optional stringish" id="registration_emergency_person_attributes_street_input"><label class=" label" for="registration_emergency_person_attributes_street">Straat</label><input id="registration_emergency_person_attributes_street" maxlength="60" name="registration[emergency_person_attributes][street]" type="text" /> </li> <li class="string input optional stringish" id="registration_emergency_person_attributes_number_input"><label class=" label" for="registration_emergency_person_attributes_number">Huisnummer</label><input id="registration_emergency_person_attributes_number" maxlength="10" name="registration[emergency_person_attributes][number]" size="10" type="text" /> </li> <li class="string input optional stringish" id="registration_emergency_person_attributes_extension_input"><label class=" label" for="registration_emergency_person_attributes_extension">Huisnummertoevoeging</label><input id="registration_emergency_person_attributes_extension" maxlength="10" name="registration[emergency_person_attributes][extension]" size="10" type="text" /> </li> <li class="string input optional stringish" id="registration_emergency_person_attributes_postcode_nrs_input"><label class=" label" for="registration_emergency_person_attributes_postcode_nrs">Postcode nr</label><input id="registration_emergency_person_attributes_postcode_nrs" maxlength="5" name="registration[emergency_person_attributes][postcode_nrs]" type="text" /> </li> <li class="string input optional stringish" id="registration_emergency_person_attributes_postcode_chars_input"><label class=" label" for="registration_emergency_person_attributes_postcode_chars">Postcode (ltrs)</label><input id="registration_emergency_person_attributes_postcode_chars" maxlength="2" name="registration[emergency_person_attributes][postcode_chars]" size="2" type="text" /> </li> <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 de <a href="https://kdvnet3.s3.amazonaws.com/uploads/f3e8b77a-05d5-45c0-922d-c55e371e8c52/Privacybeleid.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(''); }; $('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(''); }else{ $('input#registration_child_attributes_bsnr').removeAttr('disabled'); }; }); // show or hide select input jointly income when rerendered form in case of a validation error toggle_jointly_income($('select#registration_parents_attributes_personal_situation')[0].value); $('select#registration_parents_attributes_personal_situation').bind('change', function(){ toggle_jointly_income(this.value); }); }); </script> </div> </body> </html>