Reservation for a daycare place

Your first name *:

Your name*:

Your address *:

Your university (for students):

Your employer (for university employees):

Is there another legal guardian?:

Ja

No

Is the other legal guardian studying? *:

Ja

No

Your child's first name*:

Your child's name*:

Date of birth of your child*:

Gender of your child*:

Proof in accordance with the Measles Protection Act from March 01.03.2020, XNUMX can be provided upon admission?*:

Ja

No

The child is younger than 24 months at the desired start of the contract. Proof of vaccination is provided in accordance with the recommendations of the Standing Vaccination Commission (STIKO) and the Measles Protection Act.

The space is required from the following date. *:

If applicable, first name of your 2nd child:

If applicable, name of your 2nd child:

If applicable, date of birth of your 2nd child:

If applicable, gender of your 2nd child:

The place for the 2nd child is required from the following date:

Proof of the second child in accordance with the Measles Protection Act from March 2st, 01.03.2020 can be provided upon admission?:

Ja

No

The child is younger than 24 months at the desired start of the contract. Proof of vaccination is provided in accordance with the recommendations of the Standing Vaccination Commission (STIKO) and the Measles Protection Act.

Your e-mail address*:

Your phone number:

Your mobile number*:

Which daycare center would you like to register your child/children for?*:

When is your daycare voucher valid?:

How many hours is your daycare voucher approved for?*:

Data protection*:

The information about Privacy I have noted.