Registration form

JDK

Are you a doctor? Or serviceworker for a youth team, neighborhood team, Safe Home, institution for youth protection or youth probation? Then you can register a young person for outpatient help and/or (after-school) daytime activities at JDK. If you register someone, we assume that you do so with the consent of those involved. For children up to the age of 16, permission from the authoritative parents or guardian is required. Young people from the age of 16 can give their own consent.

If you are a parent, you can also register your child for help yourself. You do need a referral letter from a doctor or general practitioner for this. Or a decision from the municipality.

In case of an emergency, it is best to register via the website and call our general number. The registration will then be processed as soon as possible.

In other cases, we aim to process the application within 2 weeks at the latest. Did you not receive a response after 2 weeks? Send an e-mail to aanmelding@jongerendiehetkunnen.nl or call our general number 020-2101128.

We would like to ask you to fill in the form as completely as possible. If things are not applicable, fill in N/A. in.

If you still have questions about registering, you can call our general number. You will then receive one of our care coordinators on the phone.

Fill out the registration form online

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Registration details

Date of registration

Filled in by:

Referrer:

Emaila valid email

Telephone number

Information child

First and last name

Date of birth (dd/mm/jj)

Address

Postcode

City/town

Telephone number

Cultural background

BSN number

Upload photograph of the child

Upload photo

Information parent(s) / guardian(s)

Name parent/guardian 1

Telephone number

E-mailaddress

Name parent/guardian 2

Telephone number

E-mailaddress

Who has authority?

Parent/guardian 1Parent/guardian 2Other

Name of other authority

Relationship to child

Address

Postcode

City/town

Telephone number

Which help do you wish to use?

Ambulatory assistance(After-school) daytime activitiesDagbesteding ReboundAll of above

Upload the referral letterupload

Upload

Reason for registration / request for help. Describe these as specifically and extensively as possible.

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Which school does the child attend?your full name

Current youth services

Contact person at the youthservicesyour full name

Have criminal offenses been committed in the past?

YesNo

If yes, please provide a short description

0 /

Relevant history

0 /

Approach/treatment

0 /

Bijzonderheden

0 /

Additional reports or documents

Upload files

Referrer/Applicant Contact Details

reCaptcha v3

Stichting JDK’s

Naschoolse activiteiten

Door middel van het aanbieden van naschoolse sport- dans- muziek- en andere fysieksociale activiteiten vindt JDK de ingang om de deelnemers hun kwaliteiten positief te laten ervaren. Stichting JDK behandelt elk kind als uniek, en heeft ook oog voor de ondersteuningsbehoefte van elk uniek kind.

bekijk activiteiten

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