ESC Congress children daycare

1. Firstname + Lastname parent/carer *

2. Email address parent/carer *

3. Phone number parent/carer *

4. Child's name *

5. Child's surname *

6. Date of birth *

7. Gender *boygirlwould rather not say

8. Native language *

9. Does your child speaks / understands English *Yes, fluently (speaking and understanding)He/She can speak English a bit, but understands well enoughHe/she can’t speak English at all, but might understand a little bitNo, not at all

10. Does your child has any allergies *yesNo, you can go to question nr 12

11. What type of allergie(s) has your child

12. Is your child potty trained *YesNo

13. Does your child needs to take a nap during the daycare time? If so, tell us any specifics (time, duration, pacifier etc). *

14. Please tell us some relevant information about your child. What does he/she loves to do? What is typical for your child? How's your child's character? *

15. I give permission to take pictures of my children for social media. *yesnoOnly unrecognizable (for example only from the back side)

16. Select the days for your child

Bedrag *
€

Payment method *

• Card
• iDEAL

Proceed & Pay