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["Inschrijfdatum:",null,"_________________",null,null,null,"Stamboeknummer:",null,"___________________"]
["Instapdatum:",null,"_________________",null,null,null,"Stamboeknr school:",null,"___________________"]
["INSCHRIJVINGSFICHE SCHOOLJAAR 2024-2025"]
["Naam en voornaam:"]
["Geboorteplaats:",null,"",null,null,"Geboortedatum:"]
["Geslacht:",null,"M / V",null,null,"Rijksregisternr:",null,""]
["Nationaliteit:",null,"",null,null,"Nr. ID-Kaart of ISI Plus-Kaart:"]
["GSM Intern:",null,""]
[]
["Officieel Adres"]
["Straat:",null,""]
["Postcode:",null,"",null,"Plaats: ",""]
[]
["VADER/VOOGD",{"$nulls":4},"MOEDER/VOOGD"]
["Naam & voornaam:",null,"",null,null,"Naam & voornaam:",null,""]
["Geboorteplaats:",null,"",null,null,"Geboorteplaats:",null,""]
["Geboortedatum:",null,"",null,null,"Geboortedatum:",null,""]
["Nationaliteit:",null,"",null,null,"Nationaliteit:",null,""]
["Rijksregisternr:",null,"",null,null,"Rijksregisternr:",null,""]
["Straat:","",null,null,null,"Straat:",""]
["Postcode:",null,"",null,null,"Postcode:",null,""]
["Plaats:","",null,null,null,"Plaats:",""]
["Privé","telefoon","",null,null,"Privé","telefoon",""]
[null,"GSM","",null,null,null,"GSM",""]
["Werk","telefoon",null,null,null,"Werk","telefoon"]
["Familie","telefoon",null,null,null,"Familie","telefoon"]
["E-mail:","",null,null,null,"E-mail:",""]
[null,null,"",{"$nulls":4},""]
["Gegevens familiale verzekering"]
["Naam verzekeringsmaatschappij :"]
["Polisnummer : ",{"$nulls":4},""]
[]
["Bijzonderheden"]
["Briefwisseling sturen naar:"]
[]
["Indien echtgescheiden, wie is de wettelijke voogd:"]
["Sinds wanneer:"]
["Heeft de andere ouder contact met de leerling:",{"$nulls":4},"JA","NEE"]
[]
[{"$nulls":9},"Autonoom onderwijs internaat Heidehof"]
[{"$nulls":9},"Kapelsestraat 45"]
[{"$nulls":9},"2950 Kapellen"]
[{"$nulls":9},"T 03 664 42 00"]
[{"$nulls":9},"info@internaatheidehof.be | www.internaatheidehof.be"]
[]
[]
["SCHOOL 2024 - 2025"]
["Naam school:",null,"",{"$nulls":5},""]
["Adres school:",null,"",{"$nulls":5},""]
["Postcode school:",null,null,null,"gemeente:"]
[]
["Studierichting:",{"$nulls":7},"leerjaar:"]
[]
["Aankomst in het internaat na het weekend"]
["O","Komt op zondagavond naar het internaat"]
["O","Komt maandagmorgen zelfstandig naar het internaat"]
["O","Gaat maandag van thuis uit naar school "]
[]
["Vertrek op vrijdag"]
["O","Wordt vrijdag vòòr 18u00 afgehaald door: _______________________________"]
["O","Gaat zelfstandig vanuit het internaat naar huis met het openbaar vervoer (secundair)"]
["O","Vertrekt zelfstandig vanuit school naar huis (secundair)"]
["O","Wordt aan school afgehaald"]
[]
["Samenstelling gezin"]
[]
[]
[]
[]
["Ander nuttige of bijzondere gegevens over uw kind(karakter, leermoeilijkheden, gedrag, hobby's,…"]
[]
[]
[]
[]
["Om welke reden(en) heeft u voor uw kind voor een/ons internaat gekozen?  Via welke instanties?"]
[]
[]
[]
[]
["Plaatsing door OCJ"]
["Naam:",null,null,null,"Naam contactpersoon:"]
["Adres:"]
["Telefoon",null,null,null,"GSM contactpersoon:"]
["Ondergetekende verklaart dat alle gegevens, vermeld op deze inlchtingsfiche juist zijn en overeenstem-"]
["men met de huidige toestand.  Indien er zich wijzigingen voordoen in verband met één of meerdere "]
["gegevens, zal hij/zij het internaat onmiddellijk op de hoogte brengen."]
[]
["Plaats,","_________________________________",{"$nulls":4},"Datum, _________________________________"]
[]
["Handtekening vader/voogd",null,null,"Handtekening moeder/voogd",null,null,null,"Handtekening meerderjarig intern"]