{"id":9565,"date":"2023-12-04T19:37:01","date_gmt":"2023-12-04T19:37:01","guid":{"rendered":"https:\/\/kdv-fit4kids.nl\/?page_id=9565"},"modified":"2023-12-04T19:49:49","modified_gmt":"2023-12-04T19:49:49","slug":"inschrijfformulier-kdv","status":"publish","type":"page","link":"https:\/\/kdv-fit4kids.nl\/en\/inschrijfformulier-kdv\/","title":{"rendered":"Inschrijfformulier"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"9565\" class=\"elementor elementor-9565\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-333b01e elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"333b01e\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-9fe47a7\" data-id=\"9fe47a7\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b85d9a2 elementor-widget elementor-widget-text-editor\" data-id=\"b85d9a2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: center;\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f9564-o1\" lang=\"nl-NL\" dir=\"ltr\" data-wpcf7-id=\"9564\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/9565#wpcf7-f9564-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contactformulier\" novalidate=\"novalidate\" data-status=\"init\" data-trp-original-action=\"\/en\/wp-json\/wp\/v2\/pages\/9565#wpcf7-f9564-o1\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"9564\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"nl_NL\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f9564-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<h2><strong>Child information<\/strong>\n<\/h2>\n<p><label> Family name:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-famname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"familie\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-famname\" \/><\/span> <\/label>\n<\/p>\n<p><label> First name:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-voornaam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"voornaam\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-voornaam\" \/><\/span> <\/label>\n<\/p>\n<p><label> Call sign:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-roepnaam\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"roepnaam\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-roepnaam\" \/><\/span> <\/label>\n<\/p>\n<p><label>(Expected) date of birth:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-geboortedatum\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"geboortedatum\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-geboortedatum\" \/><\/span> <\/label>\n<\/p>\n<p><label> BSN Number:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-bsn\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"name\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-bsn\" \/><\/span> <\/label>\n<\/p>\n<p><label> Desired start date of placement:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-startdateplaatsing\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"startdatum\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-startdateplaatsing\" \/><\/span> <\/label>\n<\/p>\n<p><label> GP details:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-huisarts\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"huisarts\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-huisarts\" \/><\/span> <\/label>\n<\/p>\n<p><label> Insurance and policy number:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-verzekeringpolis\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"verzekering\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-verzekeringpolis\" \/><\/span> <\/label>\n<\/p>\n<h2><strong>Details of the parent(s) or guardian(s)<\/strong>\n<\/h2>\n<p><label>Name:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-parentname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"naam\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-parentname\" \/><\/span> <\/label>\n<\/p>\n<p><label>Address:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-adres\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"adres\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-adres\" \/><\/span> <\/label>\n<\/p>\n<p><label>Zipcode \/ city:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-postcodeplaats\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"postcode\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-postcodeplaats\" \/><\/span> <\/label>\n<\/p>\n<p><label>Phone:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-telefoon\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"telefoon\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-telefoon\" \/><\/span> <\/label>\n<\/p>\n<p><label>Emergency number:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-noodnummer\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"noodnummer\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-noodnummer\" \/><\/span> <\/label>\n<\/p>\n<p><label>E-mail:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-parentemail\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"e-mail\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-parentemail\" \/><\/span> <\/label>\n<\/p>\n<p><label>BSN Number:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-parentbsn\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"noodnummer\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-parentbsn\" \/><\/span> <\/label>\n<\/p>\n<p><label> Date of birth:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-parentbirthdate\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"geboortedatum\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-parentbirthdate\" \/><\/span> <\/label>\n<\/p>\n<p>&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;-\n<\/p>\n<p><label>Name:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-parentname2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"naam\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-parentname2\" \/><\/span> <\/label>\n<\/p>\n<p><label>Address:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-adres2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"adres\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-adres2\" \/><\/span> <\/label>\n<\/p>\n<p><label>Zipcode \/ city:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-postcodeplaats2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"postcode\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-postcodeplaats2\" \/><\/span> <\/label>\n<\/p>\n<p><label>Phone:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-telefoon2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"telefoon\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-telefoon2\" \/><\/span> <\/label>\n<\/p>\n<p><label>Emergency number:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-noodnummer2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"noodnummer\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-noodnummer2\" \/><\/span> <\/label>\n<\/p>\n<p><label>E-mail:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-parentemail2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"e-mail\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-parentemail2\" \/><\/span> <\/label>\n<\/p>\n<p><label>BSN Number:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-parentbsn2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"noodnummer\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-parentbsn2\" \/><\/span> <\/label>\n<\/p>\n<p><label> Date of birth:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-parentbirthdate2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"geboortedatum\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-parentbirthdate2\" \/><\/span> <\/label>\n<\/p>\n<p>Locatie: <span class=\"wpcf7-form-control-wrap\" data-name=\"menu-584\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"menu-584\"><option value=\"\">&#8212;Kies een optie&#8212;<\/option><option value=\"Locatie de Klimboom Culemborg\">Locatie de Klimboom Culemborg<\/option><option value=\"Locatie de Speelboom Tiel\">Locatie de Speelboom Tiel<\/option><\/select><\/span>\n<\/p>\n<html>\n\t<style>\ntable, th, td {\n border:0px solid black;\n margin-left: auto;\n margin-right: auto;\n}\n\t<\/style>\n\t<body>\n\t\t<table \"style=\"width:10%\">\n\t\t\t<tr>\n\t\t\t\t<th>\n\t\t\t\t<\/th>\n\t\t\t\t<th>\n\t\t\t\t\t<p>Ma.\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/th>\n\t\t\t\t<th>\n\t\t\t\t\t<p>Di.\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/th>\n\t\t\t\t<th>\n\t\t\t\t\t<p>Wo.\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/th>\n\t\t\t\t<th>\n\t\t\t\t\t<p>Do.\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/th>\n\t\t\t\t<th>\n\t\t\t\t\t<p>Vr.\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/th>\n\t\t\t<\/tr>\n\t\t\t<tr>\n\t\t\t\t<td>\n\t\t\t\t\t<p>Entire day\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/td>\n\t\t\t\t<td>\n\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"acceptance-700\"><span class=\"wpcf7-form-control wpcf7-acceptance optional\"><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"acceptance-700\" value=\"1\" aria-invalid=\"false\" \/><\/span><\/span><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/td>\n\t\t\t\t<td>\n\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"acceptance-701\"><span class=\"wpcf7-form-control wpcf7-acceptance optional\"><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"acceptance-701\" value=\"1\" aria-invalid=\"false\" \/><\/span><\/span><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/td>\n\t\t\t\t<td>\n\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"acceptance-702\"><span class=\"wpcf7-form-control wpcf7-acceptance optional\"><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"acceptance-702\" value=\"1\" aria-invalid=\"false\" \/><\/span><\/span><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/td>\n\t\t\t\t<td>\n\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"acceptance-703\"><span class=\"wpcf7-form-control wpcf7-acceptance optional\"><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"acceptance-703\" value=\"1\" aria-invalid=\"false\" \/><\/span><\/span><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/td>\n\t\t\t\t<td>\n\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"acceptance-704\"><span class=\"wpcf7-form-control wpcf7-acceptance optional\"><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"acceptance-704\" value=\"1\" aria-invalid=\"false\" \/><\/span><\/span><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/td>\n\t\t\t<\/tr>\n\t\t<\/table>\n\t\t<p><label>Hot Meals<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"select-3109\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"select-3109\"><option value=\"\">&#8212;Kies een optie&#8212;<\/option><option value=\"Structureel\">Structureel<\/option><option value=\"Incidentueel\">Incidentueel<\/option><\/select><\/span> <\/label>\n\t\t<\/p>\n\t<\/body>\n<\/html>\n<h2><strong>Special information relating to your child's health<\/strong>\n<\/h2>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"text-907\"><input size=\"200\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Comments\" value=\"\" type=\"text\" name=\"text-907\" \/><\/span><br \/>\n<input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p><input type='hidden' class='wpcf7-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<input type=\"hidden\" name=\"trp-form-language\" value=\"en\"\/><\/form>\n<\/div>\n<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-9565","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/kdv-fit4kids.nl\/en\/wp-json\/wp\/v2\/pages\/9565","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kdv-fit4kids.nl\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/kdv-fit4kids.nl\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/kdv-fit4kids.nl\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kdv-fit4kids.nl\/en\/wp-json\/wp\/v2\/comments?post=9565"}],"version-history":[{"count":11,"href":"https:\/\/kdv-fit4kids.nl\/en\/wp-json\/wp\/v2\/pages\/9565\/revisions"}],"predecessor-version":[{"id":9576,"href":"https:\/\/kdv-fit4kids.nl\/en\/wp-json\/wp\/v2\/pages\/9565\/revisions\/9576"}],"wp:attachment":[{"href":"https:\/\/kdv-fit4kids.nl\/en\/wp-json\/wp\/v2\/media?parent=9565"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}