Aanmelding - Peuteropvang Calimero oud

EN | NL

Registration for Peuteropvang Calimero oud

Requested childcare

Mocht uw huisarts niet in het keuzemenu van de huisartsen staan, dan kunt u, uw eigen huisarts toevoegen in de toelichting.

Startdate*
Enddate*

Childcare in the morning (KDV) Monday Tuesday Wednesday Thursday Friday

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
Spoken language
Gender
Citizen number (BSN)*

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

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

Parent/Guardian 1 (Who will receive the invoices)

Initials*
Firstname*
Last name prefix
Last name*
Relationship
Date of birth*
Spoken language
Citizen Number (BSN)*
Reffered for VVE (Preschool education)
Personal situation
Combined income
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

Initials
Firstname
Last name prefix
Last name
Relationship
Date of birth
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

First name
Last name prefix
Last name
Relation
Date of birth

Street
House number
House number extension
Postalcode (numbers)
Postalcode (characters)
City
Phone number (Home)
Mobilephone number
Phone number (work)

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