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Child
First name
+ Initials
Prefix(es) + Last name
Gender
Boy
Girl
Not yet known
Emergency number
+ Contact name
Emergency number + Contact name
Emergency number + Contact name
Photos allowed?
Yes
No
Date of birth
BSN
Nationality
Choose a nationality
Afghaanse
Amerikaanse
Armeense
Belgische
Bosnische
Bulgaarse
Canadese
Chileense
Chinese
Colombiaans
Congolees
Costaricaanse
Cubaanse
Deense
Duitse
Egyptische
Engelse
Eritrese
Ethiopische
Franse
Hongaarse
Ierse
Indiase
Indonesische
Iraakse
Iraans
Israëlische
Italiaanse
Japanse
Kenyaanse
Kroatische
Liberiaanse
Marokkaanse
Nederlandse
Oegandese
Oekraïense
Pakistaanse
Panamese
Peruaanse
Poolse
Portugese
Roemeense
Somalische
Spaans
Sri Lankaanse
Staatloos
Surinaamse
Syrische
Thaise
Tsjechische
Turkse
Venezolaans
Vietnamese
Zuid-Afrikaanse
Zweedse
Other...
Vaccinated?
Yes
No
Allergies?
Yes
No
Medication?
Yes
No
Diet?
Yes
No
General practitioner
Choose a GP
A. Senyurek, Rotterdam
A.B. Gan, Schiedam
A.B. Korsten, Schiedam
A.C.P.M. Roels, Rotterdam
A.J. Kreeft, Vlaardingen
B. Soerjoesing, Rotterdam
Boer Boer, Rotterdam
C Christiaansen, Vlaardingen
C.I. Veugelers & dr. Koning, Vlaardingen
Chin Atan, Huisartsengroep aan de Schie, Schiedam
D. Oei, Rotterdam
Damzicht huisartsengroep Damzicht huisartsengroep, Schiedam
Dr. Klomp, Schiedam
E. van den Broek, Vlaardingen
Huisartsenpraktijk Cimen Cimen, Rotterdam
Huisartsenpraktijk Steffe Steffens en Balvert, Rotterdam
J. van Overdam, Schiedam
K.A. Moltzer, Rotterdam
P. Van der Pas, Schiedam
P.J. Jansen, Vlaardingen
R.D. Laigsingh, Schiedam
Romeijn, 3333EL
S Gonesh, Schiedam
W.A.J. Bloot, Schiedam
gezondheidscentrum sanita Sanitas, Rotterdam
Other...
Health insurance + Policy number
Desired placement
Type of care
Choose the type of care..
Daycare
Out-of-school care
Location
Choose a location..
BSO Academia
KDV Wonderkids
Preferred start date
Particulars
e.g. medical particulars, planning-related matters etc.
Age
from 0 to 4 years!
Daycare 40 weeks from 7:00 to 18:15
Scroll right for more options
Monday
Tuesday
Wednesday
Thursday
Friday
9 weeks holiday care from 7:00 to 18:15
Scroll right for more options
Monday
Tuesday
Wednesday
Thursday
Friday
12 weeks holiday care from 7:00 to 18:15
Scroll right for more options
Monday
Tuesday
Wednesday
Thursday
Friday
Age
from 4 to 13 years!
Primary school
Choose a primary school
Ibs Ababil
Ibs El Furkan
Ibs de Kubus
Kinderopvang
Taaltuin
Other...
Morning
from 07:00 to 08:30
Scroll right for more options
Monday
Tuesday
Wednesday
Thursday
Friday
Afternoon
from 15:15 to 18:15
Scroll right for more options
Monday
Tuesday
Wednesday
Thursday
Friday
9 weeks holiday care from 7:00 to 18:15
Scroll right for more options
Monday
Tuesday
Wednesday
Thursday
Friday
12 weeks holiday care from 7:00 to 18:15
Scroll right for more options
Monday
Tuesday
Wednesday
Thursday
Friday
1st parent / carer / contractor
First name
+ Initials
Prefix(es) + Last name
Gender
Male
Female
Date of birth
BSN
Nationality
Choose a nationality
Afghaanse
Amerikaanse
Armeense
Belgische
Bosnische
Bulgaarse
Canadese
Chileense
Chinese
Colombiaans
Congolees
Costaricaanse
Cubaanse
Deense
Duitse
Egyptische
Engelse
Eritrese
Ethiopische
Franse
Hongaarse
Ierse
Indiase
Indonesische
Iraakse
Iraans
Israëlische
Italiaanse
Japanse
Kenyaanse
Kroatische
Liberiaanse
Marokkaanse
Nederlandse
Oegandese
Oekraïense
Pakistaanse
Panamese
Peruaanse
Poolse
Portugese
Roemeense
Somalische
Spaans
Sri Lankaanse
Staatloos
Surinaamse
Syrische
Thaise
Tsjechische
Turkse
Venezolaans
Vietnamese
Zuid-Afrikaanse
Zweedse
Other...
Marital status
Choose marital status
Alleenstaand
Gehuwd
Geregistreerd Partnerschap
Gescheiden
Ongehuwd
Samenwonend
Weduwe/weduwnaar
Relationship to the child
Choose a relationship
Broer
Buurman
Buurvrouw
Moeder
Neef
Nicht
Oma
Oom
Opa
Pleegmoeder
Pleegvader
Stiefbroer
Stiefmoeder
Stiefvader
Stiefzus
Tante
Vader
Verzorger
Voogd
Vriend
Vriendin
Zus
Other...
Home phone
Mobile phone
Work phone
Email address
Newsletter/Memos
Yes
No
Would you like to join the parent committee?
Yes
No
Parent committee email
Yes
No
Street
+ House number
+ Addition
Postal code
+ City
The following questions relate to possible participation in an early childhood education (VVE) programme:
Education level
Choose an education level
Basisschool
Geen opleiding
HBO
LBO
MBO
Onbekend
Universiteit
Other...
Name of the education
Location of the education
Diploma obtained
+ Year
Yes
No
What is your occupation?
Are you employed?
Yes
No
Do you have your own business?
Yes
No
Are you a student?
Yes
No
Do you receive student finance?
Yes
No
Are you following a reintegration programme?
Yes
No
Are you following a civic integration course?
Yes
No
Do you receive benefits?
Yes
No
If so, which?
(e.g. social assistance, WW, WAO)
If so, what is the start date of the benefit?
2nd parent / carer
First name + Initials
Prefix(es) + Last name
Gender
Male
Female
Date of birth
BSN
Nationality
Choose a nationality
Afghaanse
Amerikaanse
Armeense
Belgische
Bosnische
Bulgaarse
Canadese
Chileense
Chinese
Colombiaans
Congolees
Costaricaanse
Cubaanse
Deense
Duitse
Egyptische
Engelse
Eritrese
Ethiopische
Franse
Hongaarse
Ierse
Indiase
Indonesische
Iraakse
Iraans
Israëlische
Italiaanse
Japanse
Kenyaanse
Kroatische
Liberiaanse
Marokkaanse
Nederlandse
Oegandese
Oekraïense
Pakistaanse
Panamese
Peruaanse
Poolse
Portugese
Roemeense
Somalische
Spaans
Sri Lankaanse
Staatloos
Surinaamse
Syrische
Thaise
Tsjechische
Turkse
Venezolaans
Vietnamese
Zuid-Afrikaanse
Zweedse
Other...
Marital status
Choose marital status
Alleenstaand
Gehuwd
Geregistreerd Partnerschap
Gescheiden
Ongehuwd
Samenwonend
Weduwe/weduwnaar
Relationship to the child
Choose a relationship
Broer
Buurman
Buurvrouw
Moeder
Neef
Nicht
Oma
Oom
Opa
Pleegmoeder
Pleegvader
Stiefbroer
Stiefmoeder
Stiefvader
Stiefzus
Tante
Vader
Verzorger
Voogd
Vriend
Vriendin
Zus
Other...
Home phone
Mobile phone
Work phone
Email address
Newsletter/Memos
Yes
No
Would you like to join the parent committee?
Yes
No
Parent committee email
Yes
No
Street + House number + Addition
Postal code + City
The following questions relate to possible participation in an early childhood education (VVE) programme:
Education level
Choose an education level
Basisschool
Geen opleiding
HBO
LBO
MBO
Onbekend
Universiteit
Other...
Name of the education
Location of the education
Diploma obtained + Year
Yes
No
What is your occupation?
Are you employed?
Yes
No
Do you have your own business?
Yes
No
Are you a student?
Yes
No
Do you receive student finance?
Yes
No
Are you following a reintegration programme?
Yes
No
Are you following a civic integration course?
Yes
No
Do you receive benefits?
Yes
No
If so, which?
(e.g. social assistance, WW, WAO)
If so, what is the start date of the benefit?
Copy address details
Clear data 2nd parent/carer
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