</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="WhU9FdXvOwQ+bvHQbSWP+vZUIG+hdNHeRTlDPmthjww=" /></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>U kunt kiezen voor een 52 weken contract inclusief alle schoolvakanties of een 40 weken contract exclusief schoolvakanties. Met een 40 weken contract kunt u nog wel extra vakantiedagen aanvragen, deze worden achteraf extra gefactureerd bovenop uw regulieren factuur.</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="844839">(Vlissingen) Huisartsenpraktijk de Golfslag, </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="844940">(Middelburg) Makdo Mondzorg, </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> <li> <li class="select input optional" id="registration_consent_5493_input"><label class=" label" for="registration_consent_5493">Ik geef toestemming om mijn kind te laten slapen in een buitenbedje</label><select id="registration_consent_5493" name="registration[consent][5493]"><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_7010_input"><label class=" label" for="registration_consent_7010">Vanaf de startdatum tot de einddatum van dit contract, geef ik toestemming voor het opvangen van mijn kind op een tweede stamgroep, zoals beschreven in het pedagogisch werkplan, zichtbaar op www.maneblussertjes.nl</label><select id="registration_consent_7010" name="registration[consent][7010]"><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 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 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 optional stringish" id="registration_parents_attributes_email_1_input"><label class=" label" for="registration_parents_attributes_email_1">Email</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 id="form-submit-button" name="commit" type="submit" value="Aanmelding verzenden" /></li> </ol></fieldset></div> </form> </div> <script> $( "form#new_registration" ).submit(function( event ) { $('#form-submit-button').prop("disabled", true); }); function showRegistrationBicCode(){ if ($('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>