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After school care

If you want to register your child for after school care at one of our child centres, please complete the application form and send it. We will soon contact you about your application. If your child is already in day care at one of our centres, you will also need to apply separately for after school care. He/she will not be placed on the waiting list automatically.

If you receive a benefit from the Social Services you can apply at Dak kindercentra with a letter from the municipality in which is stated that you are following a reintegration program. As a student you must have a current school declaration to register yourself at Dak kindercentra.

Application form After school care

Details applicant

Initials	*
Prefix
Last name	*
Gender	*	Male Female
Home telephone	*
E-mail	*
Are you familiar with Dak kindercentra	*	Yes No

Client number	*

Date of birth	*	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 jan feb mrt apr mei jun jul aug sept okt nov dec 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Social security n° (!) = Social security n°	*
Address	*
Postal code	*
City	*
Work telephone
Mobile phone
Banknumber	*
Do you have a life partner?	*	Yes No

Details life partner

Initials	*
Prefix
Last name	*
Gender	*	Male Female
Date of birth	*	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 jan feb mrt apr mei jun jul aug sept okt nov dec 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Social security n° (!) = Social security n°	*
Address	*
Postal code	*
City	*
Home telephone	*
Work telephone
Mobile phone

Details child

First name
Prefix
Last name
Gender		Boy Girl
Date of birth	*	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 jan feb mrt apr mei jun jul aug sept okt nov dec 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Social security n° (!) = Social security n°
Do you have more children placed at a child centre of Dak kindercentra?		Yes No

Name child	Date of birth
	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 jan feb mrt apr mei jun jul aug sept okt nov dec 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 jan feb mrt apr mei jun jul aug sept okt nov dec 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Your preferences

Select the centre of you choice
First choice	*	-- make your choice -- Koningin EmmakadeLamgroenCapadosestraatJulialaantjeWithuysstraatP. LangendijkstraatSteenwijklaanTinaarlostraatWijhestraatDelflandlaanElzendreefFransstraatSpinozalaanValkhofMarterradePachtersdreefWolweversgaardeSchelpkadeSumatrastraatPaets van TroostwijkstraatDen Helderstraat 256Acaciastraat 182StokroosstraatDaal en BergselaanDaal en Bergselaan 50aMozartlaanFonteynenburghlaan 38MontessoristraatOranje NassaustraatParadijsstraatBaambruggestraat 2-4/14EscamplaanWalenburg 25DunklerstraatLaan van PootParkietlaanVan BeverningkstraatVerhulstplein TheresiastraatAmetisthorst 421Ametisthorst 425GradalandTeniersstraatVermeerstraatCylinderstraatKokosnootstraatMaurice RavelwegBeijersstraatDe la Reyweg
Co-operating schools (1)
Second choice		-- make your choice -- Koningin EmmakadeLamgroenCapadosestraatJulialaantjeWithuysstraatP. LangendijkstraatSteenwijklaanTinaarlostraatWijhestraatDelflandlaanElzendreefFransstraatSpinozalaanValkhofMarterradePachtersdreefWolweversgaardeSchelpkadeSumatrastraatPaets van TroostwijkstraatDen Helderstraat 256Acaciastraat 182StokroosstraatDaal en BergselaanDaal en Bergselaan 50aMozartlaanFonteynenburghlaan 38MontessoristraatOranje NassaustraatParadijsstraatBaambruggestraat 2-4/14EscamplaanWalenburg 25DunklerstraatLaan van PootParkietlaanVan BeverningkstraatVerhulstplein TheresiastraatAmetisthorst 421Ametisthorst 425GradalandTeniersstraatVermeerstraatCylinderstraatKokosnootstraatMaurice RavelwegBeijersstraatDe la Reyweg
Co-operating schools (2)
Third choice		-- make your choice -- Koningin EmmakadeLamgroenCapadosestraatJulialaantjeWithuysstraatP. LangendijkstraatSteenwijklaanTinaarlostraatWijhestraatDelflandlaanElzendreefFransstraatSpinozalaanValkhofMarterradePachtersdreefWolweversgaardeSchelpkadeSumatrastraatPaets van TroostwijkstraatDen Helderstraat 256Acaciastraat 182StokroosstraatDaal en BergselaanDaal en Bergselaan 50aMozartlaanFonteynenburghlaan 38MontessoristraatOranje NassaustraatParadijsstraatBaambruggestraat 2-4/14EscamplaanWalenburg 25DunklerstraatLaan van PootParkietlaanVan BeverningkstraatVerhulstplein TheresiastraatAmetisthorst 421Ametisthorst 425GradalandTeniersstraatVermeerstraatCylinderstraatKokosnootstraatMaurice RavelwegBeijersstraatDe la Reyweg
Co-operating schools (3)
Is your child already registered on a primary school?		Yes No
Name primary school		-- make your choice -- Annie M.G. Schmidtschool (O)Archipel, De (O) Ark, De (PC)Baanbreker, De (O)Bavinckschool (PC) Boldinghschool, De Buutplaats, De (RK)Christelijke Montessorischool (PC) Da Costaschool (PC)Daltonschool Helen Parkhurst (O) De la Reyschool (O)Deltaschool (O)Dependance Daltonschool Helen Parkhurst (O) (Den Helderstraat 110-112) Dependance de Kleine Wereld (O)Dependance het Startpunt, Ferdinand Bolstraat 33 (O)Dependance Rosaschool (RK) Dijsselbloem, De (RK)Drentse Hoek, De (O)Drie Linden, De (RK)Driemaster, De (PC)Erasmusschool (O)Essesteijnschool (O)Gelderlandschool (O)Groen van Prinstererschool (IC)Haagsche Schoolvereeniging, DeHoogstratenschool, van (PC)Horizon, De (PC)Houtrustschool (O)J.A. Gerth van Wijkschool, Dr. (PC)Jan van Nassauschool (PC)Jenaplanschool Grote Beer (RK)Jeroen (RK)John F. Kennedyschool (RK)Jonge Wereld, De (RK)Kameleon, De (O)Kleine Wereld, De (O)Koningin Beatrixschool (PC) Krullevaar, De (RK)Leeuwerikhoeve, De (O)Liduina Basisschool (RK)Lusthof, De (RK)Mariaschool (RK)Max Velthuijs school (O)Montessorischool Nieuw Vreugd en Rust (AB)Montessorischool Prinses Marijke (O)Montessorischool Valkenbos (O)Nutsbasisschool Bezuidenhout (AB) Nutsbasisschool M.M. Boldingh (AB)Nutsschool Laan van Poot (AB)Oase, De (RK)Ontmoeting, De (PC)Onze Wereld (RK) Ostadeschool, Van (O)P. Oosterleeschool (PC)Palet, Het (RK)Parachute, De (O)Parkiet, De (RK)Petrus Dondersschool (RK)Pius X (RK) Prins Willem Alexanderschool (O) Prof. Casimirschool (O)Regenboog, De (RK)Rosaschool (RK) Shri Vishnuschool (AB) Spectrum, Het (O) Spiegel, De (PC)Spoorzoeker, De (O)Springbok, De (O)Springplank, De (PC) (voor speciaal basisonderwijs)St. Maartenschool (RK)Statenkwartierschool (IC)Trampoline, DeVijverhof, De (PC)Vlierboom, De (O)Vliermeent, De (PC)Vrije school Wonnebald (AB)Vuurvlinder, De (O) Waalse Louise de Colignyschool (PC) Wereldwijzer, De (RK)Willem Drees, Dr. (O)WillemsparkWissel, De (O)Zonnebloemschool (O)Zonnelicht, Het (fusie De Dobbelsteen en Koningin Wilhelminaschool) (IC)Zuidwalschool, De (O)Zuidwester, De (RK) Other,

If your child attends a primary school which has no co-operation with the child centre, you will have to take care of his transport from school to the centre.

Required care

Care		Time	Mo	Tu	We	Th	Fr
After school care (including the Dutch school holidays)		until 6.30 pm
Child care on Friday afternoon between ± 12 am-3 pm **		until 6.30 pm
Holiday care (12 weeks)		until 6.30 pm

Preferred date of commencement	*	1 16 jan feb mar apr may jun jul aug sep oct nov dec 201220132014201520162017

** It concerns early after school care from noon until 3 p.m at the following centres: Anne Dak Witte de Withstraat, Daan Dak Lamgroen, Laura Dak Cederstraat and Pien Dak Theresiastraat.

Information supply

How would you like to receive your monthly invoice?	*		By e-mail
			By mail
How would you like to receive other information (such as the corporate newsletter)?	*		By e-mail
			By mail

Comments

Do you have any comments or suggestions?

Other information

How did you find Dak kindercentra?

Advertising			Newspaper
			Yellow pages/Telephone book
			Leaflet
			Advertisement in public areas
			Triangle advertising on the streets (on lamp posts)
			Information received from midwife (Zwangerschapskoffer)

Internet			Dakkindercentra.nl
			Kinderopvangonline.nl
			Kinderopvangkaart.nl
			Google

Social Media			Facebook
			Hyves
			Twitter

Mouth to Mouth			Friends/family
			Employer
			School
			St. Tiri
			Already familiar with Dak kindercentra

Was one of your children at any time placed in a childcare centre from another organisation?			Yes
			No
Name organisation

		Send
* fields are obligatory

NB: Met afgifte van uw e-mailadres gaat u akkoord met opname van uw e-mailadres in onze klantendatabase. Dak kindercentra respecteert uw privacy en zorgt ervoor dat uw gegevens vertrouwelijk worden behandeld. Dak kindercentra verstrekt uw gegevens niet aan derden. De plaatsingsovereenkomst ontvangt u altijd per post ter ondertekening.

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