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Title parent/carer 1
*
Make your choice
Mr.
Mrs.
Ms.
Initials parent/carer 1
*
Surname parent/carer 1
*
Street and house number
*
Postcode
Town/City
*
(Mobile) telephone number
*
E-mail address
*
Title parent/carer 2
Make your choice
Mr.
Mrs.
Ms.
Initials parent/carer 2
Surname parent/carer 2
Street and house number
Postcode
Town/City
Country
(Mobile) telephone number
E-mail address
Child's surname
*
Child's first name (if known)
Gender
Unknown
Boy
Girl
(Expected) date of birth
*
Type of childcare
*
Daycare (children aged 0 to 4)
Playgroup (children aged 2 to 4)
Out-of-school care (children aged 4 to 13)
Before-school care (children aged 4 to 13)
Desired childcare center(s) or the name of your primary school (if known)
*
Desired start date
*
Desired day(s)
*
Monday
Tuesday
Wednesday
Thursday
Friday
Do you want to add another child?
Make your choice
Yes
No
Child's surname
Child's first name (if known)
Gender
Unknown
Boy
Girl
(Expected) date of birth
*
Type of childcare
*
Daycare (children aged 0 to 4)
Playgroup (children aged 2 to 4)
Out-of-school care (children aged 4 to 13)
Before-school care (children aged 4 to 13)
Desired childcare center(s) or the name of your primary school (if known)
*
Desired start date
*
Desired day(s)
*
Monday
Tuesday
Wednesday
Thursday
Friday
Additional questions or comments
Send this form