Registration

Kitas Forms

Preferred Daycare Center

Preferred Daycare Center 1*

Preferred Daycare Center 2

Preferred Daycare Center 3

Desired date of entry

Select date:*

Desired care times

Monday

Tuesday

Wednesday

Thursday

Friday

Flexibility in occupancy

Flexible care days: Other care days are also possible.

Flexible occupancy: More ore less care days per week are also possible.

Siblings

Child

First name*

Family name*

Street, Nr.*

PLZ*

Location*

Date of birth (or expected)

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

Other employer

Parents: father

Salutation

First name*

Family name*

Street, Nr.*

PLZ*

Location*

Mobile phone

Tel business

Tel private

E-Mail business*

E-Mail private*

Arbeitgeber/Firma

Other employer

Miscellaneous

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

For employees of member companies

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

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

Annotations

I'd like to receive 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

Postcard

Print media

Other

In a different way