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font-size: inherit; font-weight: inherit; height: 24px; } .formtastic input[type='submit']{ height: 24px; } .logo { background-image: url(https://kdvnet3.s3.amazonaws.com/uploads/9a584312-9ef4-4a7a-b2fa-fe362fb171f0/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 - IKC de Regenboog</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="Y80U8qtLS+3E2IVG/tt7TwytcTmsegQg/iCqKTyFhug=" /></div><input id="registration_token" name="registration_token" type="hidden" value="lGeELJyhNRr4AgFbnmCv" /> <div class='form_group' id='parent'> <h3 class='registration'>Toelichting</h3> <h4><p>U kunt kiezen voor een 40 weken contract of een 52 weken contract.</p> <p>Wanneer u een 52 weken contract wilt afnemen kruist u eerst de benodigde dagen aan en kruist u vervolgens dezelfde dagen aan bij "dagen inclusief vakantie"</p> <p>Onze peuteropvang bieden we alleen aan in de 40 schoolweken op woensdag en vrijdag. </p> <p>Onze hele dagopvang bieden we aan van maandag t/m vrijdag van:</p> <p>7/7.30 uur - 18 uur of</p> <p>7/7.30 uur - 15 uur</p> <p>Op woensdag en vrijdag is het ook mogelijk om van 07.00/07.30 tot 13.00 af te nemen. Graag uw keuze voor het eindtijdstip vermelden bij 'toelichting'. </p> <p>Onze voorschoolse opvang bieden we aan van maandag t/m vrijdag. </p> <p>Onze naschoolse opvang bieden we aan op maandag, dinsdag, donderdag en vrijdag.</p> </h4> <br> <fieldset class="inputs"><ol><li class="string input required stringish" id="registration_preferred_start_date_input"><label class=" label" for="registration_preferred_start_date">Startdatum<abbr title="required">*</abbr></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'>Peuteropvang ochtend</label> <input id="monday_toddler_morning" name="monday_toddler_morning" type="checkbox" value="true" /> Maandag <input id="tuesday_toddler_morning" name="tuesday_toddler_morning" type="checkbox" value="true" /> Dinsdag <input id="wednesday_toddler_morning" name="wednesday_toddler_morning" type="checkbox" value="true" /> Woensdag <input id="thursday_toddler_morning" name="thursday_toddler_morning" type="checkbox" value="true" /> Donderdag <input id="friday_toddler_morning" name="friday_toddler_morning" type="checkbox" value="true" /> Vrijdag </li> </ol> </fieldset> <fieldset class='inputs'> <ol> <li class='input'> <label class='label'>Dagen VSO</label> <input id="monday_vso" name="monday_vso" type="checkbox" value="true" /> Maandag <input id="tuesday_vso" name="tuesday_vso" type="checkbox" value="true" /> Dinsdag <input id="wednesday_vso" name="wednesday_vso" type="checkbox" value="true" /> Woensdag <input id="thursday_vso" name="thursday_vso" type="checkbox" value="true" /> Donderdag <input id="friday_vso" name="friday_vso" type="checkbox" value="true" /> Vrijdag </li> </ol> </fieldset> <fieldset class='inputs'> <ol> <li class='input'> <label class='label'>Dagen NSO</label> <input id="monday_nso" name="monday_nso" type="checkbox" value="true" /> Maandag <input id="tuesday_nso" name="tuesday_nso" type="checkbox" value="true" /> Dinsdag <input id="wednesday_nso" name="wednesday_nso" type="checkbox" value="true" /> Woensdag <input id="thursday_nso" name="thursday_nso" type="checkbox" value="true" /> Donderdag <input id="friday_nso" name="friday_nso" 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 required stringish" id="registration_child_attributes_initials_input"><label class=" label" for="registration_child_attributes_initials">Initialen<abbr title="required">*</abbr></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 required stringish" id="registration_child_attributes_date_of_birth_input"><label class=" label" for="registration_child_attributes_date_of_birth">Geboortedatum<abbr title="required">*</abbr></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="N">neutraal</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="select input optional" id="registration_child_attributes_class_room_input"><label class=" label" for="registration_child_attributes_class_room_id">Klas/School</label><select id="registration_child_attributes_class_room_id" name="registration[child_attributes][class_room_id]"><option value=""></option> <option value="163893">Acaciahof Centrum - Middelburg - Groep ? - </option> <option value="162371">Acaciahof Klarenbeek - Middelburg - Groep ? - </option> <option value="162363">Acaciahof Klarenbeek - Middelburg - Groep 1 - </option> <option value="162364">Acaciahof Klarenbeek - Middelburg - Groep 2 - </option> <option value="162365">Acaciahof Klarenbeek - Middelburg - Groep 3 - </option> <option value="162366">Acaciahof Klarenbeek - Middelburg - Groep 4 - </option> <option value="162367">Acaciahof Klarenbeek - Middelburg - Groep 5 - </option> <option value="162368">Acaciahof Klarenbeek - Middelburg - Groep 6 - </option> <option value="162369">Acaciahof Klarenbeek - Middelburg - Groep 7 - </option> <option value="162370">Acaciahof Klarenbeek - Middelburg - Groep 8 - </option> <option value="162362">Herman Faukeliusschool - Middelburg - Groep ? - </option> <option value="162354">Herman Faukeliusschool - Middelburg - Groep 1 - </option> <option value="162355">Herman Faukeliusschool - Middelburg - Groep 2 - </option> <option value="162356">Herman Faukeliusschool - Middelburg - Groep 3 - </option> <option value="162357">Herman Faukeliusschool - Middelburg - Groep 4 - </option> <option value="162358">Herman Faukeliusschool - Middelburg - Groep 5 - </option> <option value="162359">Herman Faukeliusschool - Middelburg - Groep 6 - </option> <option value="162360">Herman Faukeliusschool - Middelburg - Groep 7 - </option> <option value="162361">Herman Faukeliusschool - Middelburg - Groep 8 - </option> <option value="163892">Het Talent - Middelburg - Groep ? - </option> <option value="163884">Het Talent - Middelburg - Groep 1 - </option> <option value="163886">Het Talent - Middelburg - Groep 2 - </option> <option value="163885">Het Talent - Middelburg - Groep 3 - </option> <option value="163887">Het Talent - Middelburg - Groep 4 - </option> <option value="163888">Het Talent - Middelburg - Groep 5 - </option> <option value="163889">Het Talent - Middelburg - Groep 6 - </option> <option value="163890">Het Talent - Middelburg - Groep 7 - </option> <option value="163891">Het Talent - Middelburg - Groep 8 - </option> <option value="163737">Palmenhof - Middelburg - Groep ? - </option> <option value="162353">Regenboogschool - Middelburg - Groep ? - </option> <option value="162345">Regenboogschool - Middelburg - Groep 1 - </option> <option value="162346">Regenboogschool - Middelburg - Groep 2 - </option> <option value="162347">Regenboogschool - Middelburg - Groep 3 - </option> <option value="162348">Regenboogschool - Middelburg - Groep 4 - </option> <option value="162349">Regenboogschool - Middelburg - Groep 5 - </option> <option value="162350">Regenboogschool - Middelburg - Groep 6 - </option> <option value="162351">Regenboogschool - Middelburg - Groep 7 - </option> <option value="162352">Regenboogschool - Middelburg - Groep 8 - </option></select> </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="840824">Angkotta, </option> <option value="840825">Den Doelder, </option> <option value="840835">de Vries en Prins, </option> <option value="840735">Dr Boeijharat, </option> <option value="840732">Dr Bruynzeel, </option> <option value="840832">Greeven, </option> <option value="840912">Huisartsenpraktijk Dauwendaele, </option> <option value="840826">Huisartsenpraktijk de Dolfijn, </option> <option value="841987">Huisartsenpraktijk JC Ponten, </option> <option value="840828">Lankhorst, </option> <option value="840873">Menzis, </option> <option value="844805">Praktijk de Getijdemolen, </option> <option value="840831">Praktijk Veere, </option> <option value="840823">Roest, </option> <option value="840833">Schinkelshoek, </option> <option value="840834">van de Bergh, </option> <option value="840827">van de Haak, </option> <option value="840830">van de Peppel, </option> <option value="840738">Van der Meer, </option> <option value="840829">van Tol, </option> <option value="840836">v.d. Peijl, </option> <option value="840872">Vervloet, </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="840847">Becker, </option> <option value="840734">Claessen en Becker, </option> <option value="840849">de Hek, </option> <option value="840840">de Klerck/ Moens, </option> <option value="840843">De Oude Vest, </option> <option value="840871">De Vervulling, </option> <option value="840845">Dieleman, </option> <option value="840846">Faria, </option> <option value="840913">Gilliam, </option> <option value="840848">Kremer, </option> <option value="840839">Kunst, </option> <option value="848327">Mathia, </option> <option value="841986">Mondzorg Dogterom, </option> <option value="840737">Paul en de Witte, </option> <option value="840736">Pellegrino, </option> <option value="840844">Picavat, </option> <option value="840838">Posthumus, </option> <option value="840733">Rackwitz , </option> <option value="840841">Schot, </option> <option value="840837">Taloen, </option> <option value="840842">v.d. Schaeff, </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 required" id="registration_consent_2567_input"><label class=" label" for="registration_consent_2567">Ik geef toestemming om gebruik te maken van foto’s voor de website<abbr title="required">*</abbr></label><select class="consent-required" id="registration_consent_2567" name="registration[consent][2567]"><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_2568_input"><label class=" label" for="registration_consent_2568">Ik geef toestemming voor het verlaten van de BSO bij buitenactiviteiten</label><select class="" id="registration_consent_2568" name="registration[consent][2568]"><option value=""></option> <option value="Ja">Ja</option> <option value="Nee">Nee</option></select> </li> </li> <li> <li class="select input required" id="registration_consent_3283_input"><label class=" label" for="registration_consent_3283">Ik geef toestemming voor het versturen van foto's in de digitale schriftjes van mij en andere ouders<abbr title="required">*</abbr></label><select class="consent-required" id="registration_consent_3283" name="registration[consent][3283]"><option value=""></option> <option value="Ja">Ja</option> <option value="Nee">Nee</option></select> </li> </li> <li> <li class="select input required" id="registration_consent_7014_input"><label class=" label" for="registration_consent_7014">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 <abbr title="required">*</abbr></label><select class="consent-required" id="registration_consent_7014" name="registration[consent][7014]"><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_10097_input"><label class=" label" for="registration_consent_10097">Ik geef toestemming dat mijn kind zonder constant toezicht buiten mag spelen op het plein en in de pannakooi (BSO)</label><select class="" id="registration_consent_10097" name="registration[consent][10097]"><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 optional stringish" id="registration_parents_attributes_initials_1_input"><label class=" label" for="registration_parents_attributes_initials_1">Initialen</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="bonusparent">Bonusouder</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 required stringish" id="registration_parents_attributes_date_of_birth_1_input"><label class=" label" for="registration_parents_attributes_date_of_birth_1">Geboortedatum<abbr title="required">*</abbr></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_profession_1_input"><label class=" label" for="registration_parents_attributes_profession_1">Beroep</label><input id="registration_parents_attributes_profession_1" maxlength="255" name="registration[parents_attributes][profession_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 required stringish" id="registration_parents_attributes_postcode_chars_1_input"><label class=" label" for="registration_parents_attributes_postcode_chars_1">Postcode (ltrs)<abbr title="required">*</abbr></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 required stringish" id="registration_parents_attributes_email_1_input"><label class=" label" for="registration_parents_attributes_email_1">Email<abbr title="required">*</abbr></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="bonusparent">Bonusouder</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_profession_2_input"><label class=" label" for="registration_parents_attributes_profession_2">Beroep</label><input id="registration_parents_attributes_profession_2" maxlength="255" name="registration[parents_attributes][profession_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="bonusparent">Bonusouder</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> </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 het <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() { var answers = []; $('.consent-required').each(function(){ var consentAnswer = $(this).val(); answers.push(consentAnswer); }); if (answers.includes('')){ alert('Selecteer Ja of Nee voor elke verplichte Toestemmingsvraag (met *).'); return false; } else { $('#form-submit-button').prop("disabled", true); } }); function showRegistrationBicCode(){ if ($('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>