Registration form Kralingen You must have JavaScript enabled to use this form. information mother name * surenaam initials * date of birth * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024202520262027202820292030203120322033203420352036203720382039204020412042204320442045 bsn * nationality street & nr * zipcode * city * email * home phone * mobile phone * work phone information father name * surname initials * date of birth * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024202520262027202820292030203120322033203420352036203720382039204020412042204320442045 bsn * nationality street & nr * zipcode * city * email. * home phone * mobile phone * work phone information child name surname date of birth * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20052006200720082009201020112012201320142015201620172018201920202021202220232024202520262027202820292030203120322033203420352036203720382039204020412042204320442045 the (expected) date of birth bsn childcare kind of childcare * toddler playgroup day-care afterschool care school name has your child already visited childcare before yes, if so what kind no previous child-care Placement wanted by * (date or asap) days number of days no preference no preference 1st choice (please tick box) mon tue wed thu fri 2nd choice (please tick box) mon tue wed thu fri 3th choice (please tick box) mon tue wed thu fri comments The fields with a * have to be filled in.
