docInternational Preschool Registration Form
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International Preschool Registration Form
GYMBOREE PLAY & MUSIC Richard-Strauss-Straße 80, 81679 München International Preschool Contract Gymboree Play & Music Starting _____________ Month / Year Child´s Information _________________________________________ Lastname, Firstname(s) (underline Name(s) used) ________ Sex _____________________ Birthdate ________________________________________ Nationality _______________________________________ Languages Spoken ____________________________________________ Street Address ________________________________________ Postal Code and City _____________________ Home Phone Number Health: Insurance Company and Insurance Number: __________________________________________________ Doctor (name, address, phone number):______________________________________________________ ______________________________________________________________________________________ Allergies/Special Needs :__________________________________________________________________ ______________________________________________________________________________________ Illnesses:_______________________________________________________________________________ ______________________________________________________________________________________ • Play2Learn GmbH Lara Edmonds Varner Widenmayerstr. 42 80538 München mobile +49 170 - 218 8736 [email protected] • Spiel- und Lernzentrum Gymboree Play & Music Forum Bogenhausen Richard-Strauss-Str. 80 81679 München tel +49 89 - 2323 2996 • HypoVereinsbank München DE 27700202700654774099 AG München HRB 176152 SteuerNr. 143/171/36561 www.gymboreedeutschland.de Mother´s Information: __________________________________________ Lastname, Firstname _______________________________________ Birthdate ____________________________________ Nationality _____________________________________________ Languages Spoken ___________________________________ Profession _____________________________________________ Employer ____________________________ ___________________________ Work Telephone Mobile Telephone ____________________________ Email Father´s Information: __________________________________________ Lastname, Firstname _______________________________________ Birthdate ____________________________________ Nationality _____________________________________________ Languages Spoken ___________________________________ Profession _____________________________________________ Employer ____________________________ ___________________________ Work Telephone Mobile Telephone ____________________________ Email Emergency Contact Information: Name:_________________________________________________________________________________ Address: _______________________________________________________________________________ Phone Number: __________________________________________________________________________ Relationship to Child: _____________________________________________________________________ • Play2Learn GmbH Lara Edmonds Varner Widenmayerstr. 42 80538 München mobile +49 170 - 218 8736 [email protected] • Spiel- und Lernzentrum Gymboree Play & Music Forum Bogenhausen Richard-Strauss-Str. 80 81679 München tel +49 89 - 2323 2996 • HypoVereinsbank München DE 27700202700654774099 AG München HRB 176152 SteuerNr. 143/171/36561 www.gymboreedeutschland.de The Following Individuals may Pick-up my Child: Name:_________________________________________________________________________________ Mobile Telephone Number:________________________________________________________________ Relationship to Child: ____________________________________________________________________ Name:_________________________________________________________________________________ Mobile Telephone Number:________________________________________________________________ Relationship to Child: ____________________________________________________________________ Name:_________________________________________________________________________________ Mobile Telephone Number:________________________________________________________________ Relationship to Child: ____________________________________________________________________ Important Information About Your Child: 1. Has your child had any experience in external childcare i.e. without parents Yes No 2. If so, where: _________________________________________________________________________ 3. Does your child wear a diaper? Yes No Only Nights 4. How do you calm your child? Do you have certain rituals? 5. Does your child have a favourite toy/stuffed animal or similar? _______________________________________________________________________________________ 6. What is the main language you speak at home with your child? _______________________________________________________________________________________ • Play2Learn GmbH Lara Edmonds Varner Widenmayerstr. 42 80538 München mobile +49 170 - 218 8736 [email protected] • Spiel- und Lernzentrum Gymboree Play & Music Forum Bogenhausen Richard-Strauss-Str. 80 81679 München tel +49 89 - 2323 2996 • HypoVereinsbank München DE 27700202700654774099 AG München HRB 176152 SteuerNr. 143/171/36561 www.gymboreedeutschland.de International Preschool Times: Mondays and Wednesdays 9:00 – 12:30, Thursdays 9:00- 12:00 (10 hours per week) Monthly Fee: 350€ + 49€ for materials and snacks for 10 hours per week Registration Fee: €75 (one time only, per child); €50 for existing Gymboree customers Direct Debit Authorization This direct debit authorization authorizes Gymboree Play & Music/Play2Learn GmbH to charge my account on a monthly basis for my child´s (childrens´) participation in Gymboree programs in Munich. Bank : ________________________________________________________________________________ Account Holder: ________________________________________________________________________ IBAN : ________________________________________________________________________________ BIC: __________________________________________________________________________________ _______________________ Date, Place ___________________________________________________ Signature of Account Holder Photos Authorization Photographs of my child/children taken at Gymboree Play & Music Munich may be used on the Gymboree DACH website, Gymboree Munich Facebook page and in Gymboree Munich marketing materials. Yes No Signatures I have read and agree to the terms and conditions of Gymboree Munich´s International Preschool, a copy of which has been given to me. _______________________ City, Date • Play2Learn GmbH Lara Edmonds Varner Widenmayerstr. 42 80538 München mobile +49 170 - 218 8736 [email protected] ________________________________________ Signature • Spiel- und Lernzentrum Gymboree Play & Music Forum Bogenhausen Richard-Strauss-Str. 80 81679 München tel +49 89 - 2323 2996 • HypoVereinsbank München DE 27700202700654774099 AG München HRB 176152 SteuerNr. 143/171/36561 www.gymboreedeutschland.de
