Inquiry

Tageskindergarten Forms

Child

Fist name*

Family name*

Street, Nr.*

PLZ*

Location*

Date of birth (estimated)

Gender

Parents: mother

Salutation

First name*

Family name*

Street, Nr.*

PLZ*

Location*

Mobile phone

Tel business

Tel private

E-Mail business*

E-Mail private*

Employer/Company

Parents: father

Salutation

First name*

Family name*

Street, Nr.*

PLZ*

Location*

Mobile phone

Tel business

Tel private

E-Mail business*

E-Mail private*

Employer/company

Miscellaneous

If the addresses of mother and father differ from each other, please indicate them in the field "Annotations".

Für Mitarbeitende von Mitgliedsunternehmen

I agree that Familycare Basel in case of inquiries of the employer may announce my name.

No, I do not want Familycare Basel to announce my name.

Annotations

I'd like to receiver the Familycare Basel newsletter.

How did you hear about us?

Radiobuttons

Via the employer

Via private contacts

Google or other search engine

Social Media (Facebook, Instagram, Linkedin, Xing etc.)

Advertising flyers or brochures

Print media

Other

In a different way

Don't fill this field!