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info@doublecaring.nl
06 - 218 216 87
Kinderopvang
Basisonderwijs
POP-UP kinderopvang
EASL
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Child Intake Form
We are very happy to welcome your child(ren) at the EASL childcare, organised by Double Daycare. To make sure your child(ren) has the most wonderful time, we would love to receive some information in advance about him/her. Therefore we ask you to fill in this form. Closer towards the event, you’ll receive further information about the daycare programme. Should you need any further information, please do not hesitate to contact us: events@doubledaycare.nl Thank you in advance!
Contact: events@doubledaycare.nl
First and surname parent/carer
Required
First name
Surname
Number of children
Required
Please enter a number from
1
to
4
.
Phone number + Country code parent/carer
Required
Email address parent/carer
Required
Child information
Child’s name + surname
Required
First name
Surname
Date of birth
Required
DD slash MM slash YYYY
Gender
Required
Male
Female
Would rather not say
Native language
Required
Does your child speaks / understands English
Required
Yes, fluently (speaking and understanding)
He/she can speak English a bit, but understands well enough
He/she can't speak English at all, but might understand a little bit
No, not at all
Does your child has any allergies
Required
Yes
No
What type of allergie(s) has your child
Is your child potty trained
Required
Yes
No
Does your child need to take a nap during daycare time? If so, tell us any specifics (time, duration, pacifier etc.)
Required
Please tell us some relevant information about your child. What does he/she loves to do?
Required
Child information
Child’s name + surname
Required
First name
Surname
Date of birth
Required
DD slash MM slash YYYY
Gender
Required
Male
Female
Would rather not say
Native language
Required
Does your child speaks / understands English
Required
Yes, fluently (speaking and understanding)
He/she can speak English a bit, but understands well enough
He/she can't speak English at all, but might understand a little bit
No, not at all
Does your child has any allergies
Required
Yes
No
What type of allergie(s) has your child
Is your child potty trained
Required
Yes
No
Does your child need to take a nap during daycare time? If so, tell us any specifics (time, duration, pacifier etc.)
Required
Please tell us some relevant information about your child. What does he/she loves to do?
Required
Child information
Child’s name + surname
Required
First name
Surname
Date of birth
Required
DD slash MM slash YYYY
Gender
Required
Male
Female
Would rather not say
Native language
Required
Does your child speaks / understands English
Required
Yes, fluently (speaking and understanding)
He/she can speak English a bit, but understands well enough
He/she can't speak English at all, but might understand a little bit
No, not at all
Does your child has any allergies
Required
Yes
No
What type of allergie(s) has your child
Is your child potty trained
Required
Yes
No
Does your child need to take a nap during daycare time? If so, tell us any specifics (time, duration, pacifier etc.)
Required
Please tell us some relevant information about your child. What does he/she loves to do?
Required
Child information
Child’s name + surname
Required
First name
Surname
Date of birth
Required
DD slash MM slash YYYY
Gender
Required
Male
Female
Would rather not say
Native language
Required
Does your child speaks / understands English
Required
Yes, fluently (speaking and understanding)
He/she can speak English a bit, but understands well enough
He/she can't speak English at all, but might understand a little bit
No, not at all
Does your child has any allergies
Required
Yes
No
What type of allergie(s) has your child
Is your child potty trained
Required
Yes
No
Does your child need to take a nap during daycare time? If so, tell us any specifics (time, duration, pacifier etc.)
Required
Please tell us some relevant information about your child. What does he/she loves to do?
Required
Select day(s)
Required
Wednesday May 7: 7:30-13:30
Wednesday May 7: 13:00-19:00
Thursday May 8: 7:30-13:00
Thursday May 8: 13:00-18:00
Friday May 9: 7:30-13:00
Friday May 9: 13:00-18:00
Saturday May 10: 7:30-12:00
Saturday May 10: 12:00-16:00
Total amount
Bereken prijs
Price:
0,00 €
Payment method
*
Card
iDEAL
American Express
Discover
MasterCard
Visa
Maestro
Supported Credit Cards: American Express, Discover, MasterCard, Visa, Maestro
Card Number
Expiration Date
Security Code
Cardholder Name
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