Registration for a crèche place

Details of the child

First- and lastnames *

Date of birth *

Nationality *

Language *

Sex *

Male

Female

Particularities/Medical conditions

Please make sure you fill in all fields marked with an asterisk (*).

Details of the custodians

First- and lastnames *

Street and number *

Post code and place *

Nationality of the mother

Nationality of the father

Occupation and employer

Phone number *

E-mail address *

Entry Date

Preferred entry date *

Preferred weekly hours of care *

Yes, our child has experience in groups

Notes/Comments

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Please confirm that your personal data may be digitally stored and processed for the purpose of processing the pre-registration. All collected data will be automatically deleted after one year. Further information on the protection of your data can be found in our privacy policy.