Invoer:

Details child

Gender
Last name *
First name *
Date of birth *
Or expected date of birth.
 

Details parent/guardian

Are you already a customer of Blauwkapje?
First name *
Last name *
E-mail address *
Street Address *
Zip / Postal code
City *
Phone number

Name (second) parent/guardian

First name
Last name

Preferred days

First preference *
Monday
Tuesday
Wednessday
Thursday
Friday
Second preference
Monday
Tuesday
Wednessday
Thursday
Friday
Flexible in days?
Yes
No
Preferred starting date *
 
Where did you hear about us? *
In an email
In a newspaper article
A flyer, leaflet or poster
Via school
On social media
Via Google
From family members or acquaintances
Via the midwives
I'm an existing customer
En/of:

Additional comments

Does your child require any special care or attention? E.g. a medical condition, medication, any medical care required or behavior problems? Add the information in the comment below. Do you prefer to inform us personally? Please contact our placing department, Phone 070 – 79 20 103.
Let us know if you have any requests

Privacy policy

We only use your data to register your child and to keep you up-to-date about Blauwkapje day care.
You must agree to our privacy statement. By registering, you also agree to the general and additional terms and conditions. 
I have read and understood this, and accept *
* Required fields