Registration form - Villa Valentijn Den Haag

Registration

You can fill out the registration form below. We will then be in contact with you shortly. There is not registration fee.

All-in package

All-in means that we are providing everything that is needed for the proper care of your child, including diaper and baby food (with the exception of allergy products, such as Nutrilon-Pepti, soya milk, etc.).

Parents/guardians

Initials and surname mother*

Initials and surname father

Address*

Zipcode *

Domicile *

Bank account number

Account Name *

IBAN *

BIC

Contact details

Mother's email address *

Father's email address

Telephone number *

Telephone mother *

Telephone father

Telephone mother work

Telephone father work

Emergency number 1 *

Emergency number 2

Social security number of the mother *

The fathers BSN number

Date of birth mother *

Date of birth of father

Your child's information

This is the first child that you login? *
YesNo

Gender *
BoyGirlunknown

nickname

First name/names

Surname

(Probable) Date of Birth

Social security number child

Care required from *

Preferred care

Desired care all days

Monday

Tuesday

Wednesday

Thursday

Friday

Desired care half days

Monday

Tuesday

Wednesday

Thursday

Friday

Alternative whole days

Monday

Tuesday

Wednesday

Thursday

Friday

Alternative half days

Monday

Tuesday

Wednesday

Thursday

Friday

Flexible care (min. 22 hours per month)

Would you like to make use of flexible childcare? *
YesNo

Number of half-days

Medical Information

Is your child under the control of the consultation office? *
YesNo

Dktp 1

Dktp 2

Dktp 3

Dktp 4

Bmr

Dtp

Additional information and details

Question/Comment

I agree to my data being stored and processed*

* Required field

Day nurseries are obliged to submit the personal data of the parents to the tax authorities on a monthly basis.