Small Kidz Daycare
REGISTRATION / MUTATION FORM
For more information, visit
www.smallkidz.nl
Data parent / guardian
Data 2nd parent / guardian
Child's data
Daycare data
Parent / guardian details
Initials
(required)
Last name
(required)
Sexe:
female
male
Date of birth
(required)
Phone
Email
(required)
Address
(required)
Zip code
(required)
City
(required)
Mobile
(required)
Educational institution
(required)
Employer
(required)
Phone Work
Data 2nd parent / guardian
Initials
(required)
Last name
(required)
Sexe:
male
female
Date of birth
(required)
Mobile
(required)
Phone Work
Email
Educational institution
(required)
Employer
(required)
Child's data
Last name
General practitioner
(required)
Health Insurance
(required)
(expected)
date of birth
(required)
First name
(required)
Phone number general practitioner
(required)
Health Insurance Policy number
Data day care
Type of care:
Whole day care 11 hours a day
Whole day care 10,5 hours (with 5 days contract)
Contract type:
Regular contract (51 weeks per year)
Desired starting date
(required)
Optional information:
Desired days:
Monday
Tuesday
Wednesday
Thursday
Friday