Aanmelding - Voorschool Pierewiet

EN | NL

Registration for Voorschool Pierewiet

Requested childcare

Wilt u bij de toelichting invullen wat uw gezamenlijke jaarinkomen is en tevens aangeven of u beide werkt.

Wilt u bij de toelichting aangeven of u gebruik gemaakt heeft van Mini-Samenspel?
Wij werken met combinatie groepen. Dit betekend dat u alleen kan kiezen voor een combinatie van: Maandag en Donderdag of Dinsdag en Vrijdag. Op woensdag is deze locatie gesloten.

Startdate*
Enddate*

Toddlercare in the morning (PO) Monday Tuesday Wednesday Thursday Friday

Toddlercare in the afternoon (PO) Monday Tuesday Wednesday Thursday Friday

Remark

Child

You will be able to register another child after submitting the first registration

Initials*
First name*
Last name prefix
Last name*
Phonenumber (Incase of emergency)

Date of birth*
Estimated date of birth / Not yet born
Country of birth
Nationality
Spoken language
Religion
Gender
Citizen number (BSN)*

Nickname
Allergies
Medication
Medical notes
Vaccinations
Health insurance
Health insurance policy number
May be picked-up by

Doctor/General practitioner
If your Doctor/General practitioner is not mentioned in the list, can you please write them in the remark field above?

Parent/Guardian 1 (Who will receive the invoices)

Title
Initials*
Firstname*
Last name prefix
Last name*
Relationship
Date of birth*
Country of birth
Spoken language
Religion
Citizen Number (BSN)*
Highest education
Streetname*
House number*
House number extension
Postalcode (numbers)*
Postalcode (characters)*
City*
Country*
Phone number (Home)
Mobile phone number*
Phonenumber (work)
E-mail address*
IBAN*
BIC/SWIFT code (if applicable)

Parent/Guardian 2

Title
Initials
Firstname
Last name prefix
Last name
Relationship
Date of birth
Country of birth
Spoken language
Religion
Citizen Number (BSN)
Highest education
If you do not enter an address here, the address of parent/guardian 1 will be automatically taken over.
Streetname
House number
House number extension
Postalcode (numbers)
Postalcode (characters)
City
Country
Phone number (Home)
Mobile phone number
Phonenumber (work)
E-mail address
BIC/SWIFT code (if applicable)

Emergency person

Title
Initials
First name
Last name prefix
Last name
Relation
Date of birth
Citizen number (BSN)

Street
House number
House number extension
Postalcode (numbers)
Postalcode (characters)
City
Phone number (Home)
Mobilephone number
Phone number (work)
E-mail address

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