First name of the child*
Last name of the child*
Born on*
Gender*
Please select
Male
Female
Not yet known
Nationality*
Religion*
Street and house number*
Postal code, city*
Integration child / increased support needs*
Please select
Yes
No
Not yet known
Desired entry*
Is there an emergency situation?*
Are there any siblings?*
Please select
None
1
2
3
4
Is there already a sibling at ROKIDS?*
Please select
None
1
2
3
4
Why would you like your child to join ROKIDS?
Scope of care needed
Please select
Nursery: 8 weeks to 3 years (8:00 a.m. to 4:00 p.m.)
Nursery: 8 weeks to 3 years (8:00 a.m. to 1:00 p.m.)
Age group: 3 to 6 years (8:00 a.m. to 4:00 p.m.)
Early shift from 7:00 a.m. to 8:00 a.m. desired?*
Please select
Yes
No
Late shift from 4:00 p.m. to 4:30 p.m. desired?*
Please select
Yes
No
Phone number*
Email*
Name of the mother*
Occupation*
Employer*
Type of employment*
Please select
Full-time
Part-time
Other
Name of the father*
Occupation*
Employer*
Type of employment*
Please select
Full-time
Part-time
Other
Please select the desired form(s) of contact:*
Please select
via email
by telephone
via email and by telephone