</noscript> <style> body { color: #0A1043; font-family: 'Helvetica Neue',Arial,Helvetica,sans-serif; font-size: 12px; line-height: 20px; background: #ffffff; border-top: solid 20px #d3271b; border-bottom: solid 20px #d3271b; } .registration_response{ color: #333333; font-family: 'Helvetica Neue',Arial,Helvetica,sans-serif; line-height: 1.5; } /*Settings in case a logo is uploaded, with some random settings*/ .logo_container { height: 160px; top: 0px; width: 180px; margin-right: 10px; float: right; } div#content.external{ background: #ffffff; border-radius: 0px; padding: 0; min-width: 479px; width: 80%; margin: auto; } h1, h2 { color: #75b2dd; font-weight: bold; margin: 5px; text-align: center; } h3, h4, h5, h6 { color: #333333; font-weight: bold; } h1 img, h2 img, h3 img, h4 img, h5 img, h6 img { margin: 20px; } h1 { font-size: 2em; line-height: 1; margin-bottom: 0.5em; } h2 { font-size: 2.5em; margin: 2.2em; line-height: 1; text-align: center; } h3 { font-size: 1.5em; line-height: 1; margin-bottom: 1em; } p { margin: 0 0 1.5em; } .formtastic .inline-errors { color: #cc0000; margin: 0.5em 0 0 25%; } .error { background: none repeat scroll 0 0 #fbe3e4; border: 2px solid #fbc2c4; color: #8a1f11; margin-bottom: 1em; padding: 0.8em; } .clear { clear: both; } table.timeslots { width: 550px; margin-left: -1px; } table tr td.label { width:140px; padding-left: 0px; margin: 10px; } form.formtastic { margin: 0; padding: 0; } form.formtastic ul, form.formtastic ol { margin: 0; padding: 0; list-style: none; } form.formtastic li { margin: 0; padding: 0; } form.formtastic fieldset { margin: 0; padding: 0; border: 0; display: inline-block; } form.formtastic fieldset.buttons { padding-left: 25%; } form.formtastic fieldset.buttons li { float: left; padding-right: 0.5em; } form.formtastic fieldset ol li { margin-bottom: 8px; display: inline-block; } form.formtastic fieldset ol li:after { content: '.'; display: block; height: 0; clear: both; visibility: hidden; } form.formtastic fieldset ol li label { display: block; width: 25%; float: left; padding-top: .2em; } form.formtastic fieldset ol li li label { line-height: 100%; padding-top: 0; } form.formtastic fieldset ol li li label input { line-height: 100%; vertical-align: middle; margin-top: -0.1em; } form.formtastic fieldset ol li fieldset { position: relative; } form.formtastic fieldset ol li fieldset legend { position: absolute; width: 25%; padding-top: 0.1em; } form.formtastic fieldset ol li fieldset legend span { position: absolute; } form.formtastic fieldset ol li fieldset ol { float: left; width: 74%; margin: 0; padding: 0 0 0 25%; } form.formtastic fieldset ol li fieldset ol li { padding: 0; border: 0; } form.formtastic fieldset ol li p.inline-hints { color: #666; margin: 0.5em 0 0 25%; } form.formtastic fieldset ol li p.inline-errors { color: #cc0000; margin: 0.5em 0 0 25%; } form.formtastic fieldset ol li ul.errors { color: #cc0000; margin: 0.5em 0 0 25%; list-style: square; } form.formtastic fieldset ol li ul.errors li { padding: 0; border: none; display: list-item; } form.formtastic fieldset ol li.string input, form.formtastic fieldset ol li.password input, form.formtastic fieldset ol li.numeric input, form.formtastic fieldset ol li.text textarea { width: 74%; } form.formtastic fieldset ol li.hidden { display: none; } form.formtastic fieldset ol li.boolean label { padding-left: 25%; width: auto; } form.formtastic fieldset ol li.boolean label input { margin: 0 0.5em 0 0.2em; } form.formtastic fieldset ol li.radio fieldset ol, form.formtastic fieldset ol li.check_boxes fieldset ol { margin-bottom: -0.6em; } form.formtastic fieldset ol li.radio fieldset ol li, form.formtastic fieldset ol li.check_boxes fieldset ol li { margin: 0.1em 0 0.5em 0; } form.formtastic fieldset ol li.radio fieldset ol li label, form.formtastic fieldset ol li.check_boxes fieldset ol li label { float: none; width: 100%; } form.formtastic fieldset ol li.radio fieldset ol li label input, form.formtastic fieldset ol li.check_boxes fieldset ol li label input { margin-right: 0.2em; } form.formtastic fieldset ol li.date fieldset ol li, form.formtastic fieldset ol li.time fieldset ol li, form.formtastic fieldset ol li.datetime fieldset ol li { float: left; width: auto; margin: 0 .3em 0 0; } form.formtastic fieldset ol li.date fieldset ol li label, form.formtastic fieldset ol li.time fieldset ol li label, form.formtastic fieldset ol li.datetime fieldset ol li label { display: none; } form.formtastic fieldset ol li.date fieldset ol li label input, form.formtastic fieldset ol li.time fieldset ol li label input, form.formtastic fieldset ol li.datetime fieldset ol li label input { display: inline; margin: 0; padding: 0; } form.formtastic fieldset:after { content: '.'; display: block; height: 0; clear: both; visibility: hidden; } form.formtastic legend { margin: 0; padding: 0; color: #000; } form.formtastic input, form.formtastic textarea, form.formtastic select { margin: 0; padding: 0; font-family: inherit; font-size: inherit; font-weight: inherit; font-size: 100%; } form.formtastic input{ padding: 1px 1px 0px 2px; } form.formtastic select{ padding: 1px 1px 0px 2px; height: 21px; } form.formtastic textarea{ padding: 2px; } form.formtastic p { margin: 0; padding: 0; } form.formtastic em, form.formtastic strong { font-style: normal; font-weight: normal; } form.formtastic abbr, form.formtastic acronym { border: 0; font-variant: normal; } html[xmlns] form.formtastic fieldset { display: block; } html[xmlns] form.formtastic fieldset ol li { display: block; } * html form.formtastic fieldset { height: 1%; } * html form.formtastic fieldset ol li { height: 1%; } .form_group { border-top: 1px solid #dd5900; border-bottom: 1px solid #dd5900; padding: 10px 10px 0px 10px; border-radius: 0px; width: 96%; background-color: #f0e9e3; margin: 0 auto 10px auto; } .form_group#parent { } form.formtastic span.label { color: #003366; font-size: 0.85em; font-style: normal; font-weight: bold; } form.formtastic fieldset ol li.string input { width: auto; } form.formtastic fieldset ol li.numeric input { width: auto; } .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/669664c4-a0b8-4aa2-b41a-23dc310b2a5f/profielfoto.jpg); 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 De Maneblussertjes - Schellach</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="9teei4ghYBt8TWM9Z6RMjP+B6gml5FTm+i80FSETkjk=" /></div><input id="registration_token" name="registration_token" type="hidden" value="w4zBl1aElkPjic5AywUX" /> <div class='form_group' id='parent'> <h3 class='registration'>Toelichting</h3> <h4><p>Wanneer u gebruik wil maken van flexibele opvang, klikt u één van de flexibele opvangdagen aan. U kunt bij de opmerkingen het gewenste aantal uur per maand invullen</p> </h4> <br> <fieldset class="inputs"><ol><li class="string input optional stringish" id="registration_preferred_start_date_input"><label class=" label" for="registration_preferred_start_date">Startdatum</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'>Hele dag KDV</label> <input id="monday_days" name="monday_days" type="checkbox" value="true" /> Maandag <input id="tuesday_days" name="tuesday_days" type="checkbox" value="true" /> Dinsdag <input id="wednesday_days" name="wednesday_days" type="checkbox" value="true" /> Woensdag <input id="thursday_days" name="thursday_days" type="checkbox" value="true" /> Donderdag <input id="friday_days" name="friday_days" 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 optional stringish" id="registration_child_attributes_initials_input"><label class=" label" for="registration_child_attributes_initials">Initialen</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 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="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><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="844318">(Arnemuiden) Huisartenpraktijk Arnemuiden , </option> <option value="844316">(Arnemuiden) Roelofs , </option> <option value="844311">(Borssele) Peene , </option> <option value="844313">(Domburg) Spekhorst , </option> <option value="844323">(Goes) Schmeitz, </option> <option value="844305">(Middelburg) Albers (praktijk de Vleugelnoot) , </option> <option value="844300">(Middelburg) Angkotta , </option> <option value="844306">(Middelburg) Boejharat , </option> <option value="844299">(Middelburg) Bruynzeel , </option> <option value="844308">(Middelburg) De Doelder , </option> <option value="844303">(Middelburg) Dr van Vijven/Dr Kasse , </option> <option value="844302">(Middelburg) Greeven , </option> <option value="844307">(Middelburg) Huisartenpraktijk de Dolfijn , </option> <option value="844322">(Middelburg) Huisartenpraktijk de Getijdenmolen , </option> <option value="844304">(Middelburg) Huisartenspraktijk Rozenburglaan , </option> <option value="844321">(Middelburg) Lankhorst , </option> <option value="844317">(Middelburg) Ponten , </option> <option value="844320">(Middelburg) Prins & de Vries , </option> <option value="844319">(Middelburg) Roest (praktijk de Vleugelnoot), </option> <option value="844314">(Middelburg) Van de Peppel, </option> <option value="844301">(Middelburg) Van den Bergh , </option> <option value="844315">(Oost-Souburg) Huisartsenpraktijk Meulmeester, van de Driest, </option> <option value="844342">(Oost-Souburg) Huisartsenpraktijk de Meijberg, </option> <option value="844312">(Oostkapelle) Dees , </option> <option value="844341">(Serooskerke) Dr Aulbers / Dr Schreijenberg, </option> <option value="844298">(Serooskerke) Ubels , </option> <option value="844309">(Veere) Van Slobbe, </option> <option value="844310">(Vlissingen) Van Ouwerkerk , </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="844292">(Domburg) De Haes, </option> <option value="844297">(Goes) De Ruiter, </option> <option value="844280">(Middelburg) Claessen en Bekker, </option> <option value="844291">(Middelburg) De Klerck en Moens, </option> <option value="844288">(Middelburg) Dieleman, </option> <option value="844279">(Middelburg) Gilliam, </option> <option value="844295">(Middelburg) Hintzen, </option> <option value="844277">(Middelburg) Kremer, </option> <option value="844278">(Middelburg) Kunst, </option> <option value="844282">(Middelburg) Oude Vest, </option> <option value="844284">(Middelburg) Pellegrino, </option> <option value="844296">(Middelburg) Praktijk de vervulling, </option> <option value="844276">(Middelburg) Schot, </option> <option value="844281">(Middelburg) Van der Schaaf, </option> <option value="844294">(Oost-Souburg) Dogterom, </option> <option value="844287">(Veere) De Stigter, </option> <option value="844290">(Vlissingen) De Loof, </option> <option value="844293">(Vlissingen) Paul en de Witte, </option> <option value="844289">(West-Kapelle) Van der Heijden, </option></select> </li> <li> <p class='inline-hints'>Als uw huisarts of 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 optional" id="registration_consent_4582_input"><label class=" label" for="registration_consent_4582">Ik geef toestemming voor het versturen van foto's in de digitale schriftjes van mij en andere ouders</label><select id="registration_consent_4582" name="registration[consent][4582]"><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_4583_input"><label class=" label" for="registration_consent_4583">Ik geef toestemming voor verzenden van het overdrachtsformulier (na ondertekening) naar de basisschool van mijn kind</label><select id="registration_consent_4583" name="registration[consent][4583]"><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_4584_input"><label class=" label" for="registration_consent_4584">Ik geef toestemming voor het verlaten van het kinderdagverblijf bij buitenactiviteiten</label><select id="registration_consent_4584" name="registration[consent][4584]"><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_4585_input"><label class=" label" for="registration_consent_4585">Ik geef toestemming om gebruik te maken van foto’s voor de website</label><select id="registration_consent_4585" name="registration[consent][4585]"><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_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="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_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 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 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 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="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 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="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> <li> <p> </p> </li> <li> <p> </p> </li> <li> <p> </p> <p> </p> </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 name="commit" type="submit" value="Aanmelding verzenden" /></li> </ol></fieldset></div> </form> </div> <script> 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>