Aanmelding - Peuterklas Fred Roeskestraat

EN | NL

Registration for Peuterklas Fred Roeskestraat

Requested childcare

De inschrijving is altijd voor 5 dagdelen (ochtenden van 8.45 tot 12.45), ongeacht het aantal dagdelen dat wordt aangevinkt.

Uw inschrijving is voltooid na ontvangst van het inschrijfgeld van EUR 15.- op IBAN NL29 INGB 0004904497 ten name van Stichting Vrije Peuterklassen Amsterdam.

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*
Phonenumber (Incase of emergency)

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

Nickname
Allergies
Medical notes
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*
Citizen Number (BSN)*
Streetname*
House number*
House number extension
Postalcode (numbers)*
Postalcode (characters)*
City*
Phone number (Home)
Mobile phone number*
E-mail address*
IBAN*
BIC/SWIFT code (if applicable)

Parent/Guardian 2

Title
Initials
Firstname
Last name prefix
Last name
Relationship
Date of birth
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
House number extension
Postalcode (numbers)
Postalcode (characters)
City
Phone number (Home)
Mobile phone number
E-mail address
BIC/SWIFT code (if applicable)

Emergency person

First name
Last name prefix
Last name
Relation

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