Enable the Javascript settings of your browser! Without Javascript this website will not function properly!
Thank you for your subscription.
Something went wrong sending the data to our administrationserver and generating a e-mail confirmation. Please notify us!
Do you wish for an other subscription?
Registration
Nederlandstalig inschrijfformulier / Registration form translated to Dutch
Child
First name + initials
:
prefix + Lastname
:
Sex:
Boy
Girl
Unknown
Emergency phone number
+ Contact name
:
Emergency phone number + Contact name:
Emergency phone number + Contact name:
Date of birth or due date
:
BSN
:
Nationality
:
Select a nationality
Afghaanse
Amerikaanse
Armeense
Belgische
Bosnische
Bulgaarse
Canadese
Chileense
Chinese
Congolees
Costaricaanse
Cubaanse
Deense
Duitse
Egyptische
Engelse
Eritrese
Ethiopische
Franse
Hongaarse
Ierse
Indiase
Indonesische
Iraakse
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
Vietnamese
Zuid-Afrikaanse
Zweedse
Other...
Doctor
:
Select a doctor
Other...
Desired placement
Care type
:
Select a care type
Daycare
Preschool
De Vrolijke Vis
Preferred starting date
:
Remarks:
Age:
from 0 to 4 years
Childcare days:
All day
07.30 - 18.30
Monday
Tuesday
Wednesday
Thursday
Friday
Age:
from 2 to 4 years
VVE indication
:
Yes
No
Morning:
Monday
Tuesday
Wednesday
Thursday
School
:
Select a school
Other...
Morning:
Monday
Tuesday
Wednesday
Thursday
Friday
Afternoon:
Monday
Tuesday
Wednesday
Thursday
Friday
1st parent / carer / contractor
Firstname
+ initials
:
Prefix + Lastname
:
Sex
:
Male
Female
Date of birth
:
BSN
:
Nationality
:
Select a nationality
Afghaanse
Amerikaanse
Armeense
Belgische
Bosnische
Bulgaarse
Canadese
Chileense
Chinese
Congolees
Costaricaanse
Cubaanse
Deense
Duitse
Egyptische
Engelse
Eritrese
Ethiopische
Franse
Hongaarse
Ierse
Indiase
Indonesische
Iraakse
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
Vietnamese
Zuid-Afrikaanse
Zweedse
Other...
Civil status
:
Select civil status
Married
Cohabiting
Divorced
Single
Registered partnership
Unmarried
Widow
Relationship to the child
:
Choose a relation
Mother
Father
Stepmother
Stepfather
Foster mother
Foster father
Grandmother
Grandfather
Aunt
Uncle
Niece
Nephew
Sister
Brother
Stepsister
Stepbrother
Other...
Home phone number:
Mobile phone number
:
Work phone number:
E-mailaddress
:
Street
:
House number
+ Suffix:
Postal code
:
City
:
The questions below are related to a possible participation in a pre-school route.
Education
:
Kies een opleidingsniveau
Unknown
No education
Elementary school
Primary education
Secondary education
Higher education
University
Other...
Name of education
:
Place of education
:
Diploma
+ Year
:
Yes
No
What is your profession?
:
Do you work in employment?
:
Yes
No
Do you have your own company?
:
Yes
No
Are you a student?
:
Yes
No
Do you receive a student loan?
:
Yes
No
Are you following a reintegration process?
:
Yes
No
Are you following an integration course?
:
Yes
No
Benefit
:
Yes
No
If so, what kind of benefit?
:
If so, what start date?
:
2nd parent / carer
Firstname + initials:
Prefix + Lastname:
Sex:
Male
Female
Date of birth
:
BSN
:
Nationality:
Select a nationality
Afghaanse
Amerikaanse
Armeense
Belgische
Bosnische
Bulgaarse
Canadese
Chileense
Chinese
Congolees
Costaricaanse
Cubaanse
Deense
Duitse
Egyptische
Engelse
Eritrese
Ethiopische
Franse
Hongaarse
Ierse
Indiase
Indonesische
Iraakse
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
Vietnamese
Zuid-Afrikaanse
Zweedse
Other...
Civil status:
Select civil status
Married
Cohabiting
Divorced
Single
Registered partnership
Unmarried
Widow
Relationship to the child:
Choose a relation
Mother
Father
Stepmother
Stepfather
Foster mother
Foster father
Grandmother
Grandfather
Aunt
Uncle
Niece
Nephew
Sister
Brother
Stepsister
Stepbrother
Other...
Home phone number:
Mobile phone number:
Work phone number:
E-mailaddress:
Street:
House number + Suffix:
Postal code:
City:
The questions below are related to a possible participation in a pre-school route.
Education
:
Kies een opleidingsniveau
Unknown
No education
Elementary school
Primary education
Secondary education
Higher education
University
Other...
Name of education:
Place of education:
Diploma + Year
:
Yes
No
What is your profession?:
Do you work in employment?
:
Yes
No
Do you have your own company?:
Yes
No
Are you a student?:
Yes
No
Do you receive a student loan?:
Yes
No
Are you following a reintegration process?:
Yes
No
Are you following an integration course?:
Yes
No
Benefit
:
Yes
No
If so, what kind of benefit?
:
If so, what start date?
:
Copy address details
Clear data 2nd parent/carer
General
Send
The data is sent!
Validating can take a little while. Please wait...
Clear all entered data