Aanmelding - Prinsen & Prinsessen

EN | NL

Registration for Prinsen & Prinsessen

Requested childcare

Aandachtspunten voor dit formulier:

-- GELIEVE DIT FORMULIER NIET TE GEBRUIKEN MET INTERNET EXPLORER!

-- De velden met een * teken zijn verplicht om uw registratie te kunnen verzenden.

-- Einddatum is maximaal de dag dat uw kind 4 jaar wordt.

-- Zou u in de toelichting aan kunnen geven of het om Contract 1 (=> 49 weken opvang => € 70,35 per dag) of Contract 2 (=> 40 weken opvang => € 75,60 per dag) gaat.

Startdate*
Enddate*

Remark

Child

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

Initials
First name*
Last name prefix
Last name*

Date of birth
Estimated date of birth / Not yet born
Gender*
Citizen number (BSN)

Nickname
Medical notes
May be picked-up by

Parent/Guardian 1 (Who will receive the invoices)

Title
Initials*
Firstname
Last name prefix
Last name*
Date of birth*
Spoken language
Citizen Number (BSN)*
Streetname*
House number*
Postalcode (numbers)*
Postalcode (characters)*
City*
Phone number (Home)
Mobile phone number
Phonenumber (work)
E-mail address*
IBAN

Parent/Guardian 2

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

Emergency person

Initials
First name
Last name prefix
Last name
Relation

Phone number (Home)
Mobilephone number
Phone number (work)
E-mail address