Registration form

  • Please use the form on the Dutch part of this website, look for “Inschrijfformulier” (this English form is not working at the moment) to register with us for maternity care. Under the header ‘After registering’, you can read more about how registration works.

Unfortunately we are already full till the end of December 2023, January 2024 we have still avalibility, February 2024  we are full. From March 2024 we have avalibility.

    Initials: *
    Last name: *
    E-mail address: *
    Address: *
    Phone number:
    Language mother: *
    Expected birth date of child: *
    Desired place of delivery *:
    Other place of delivery:
    Type of residence:
    Do you have pets? *:
    If yes, which pets do you have? *:

    First name: *
    Maiden name: *
    Zip code and city: *
    Mobile phone: *
    Passport identification number: *
    Date of birth mother: *
    Civil status *:
    Current number of children: *
    If you have more children, please enter their names and birth dates below:
    First names and birth dates children:

    First name partner:
    Last name partner:

    Mobile phone partner:
    Birth date partner:


    * Obligatory fields

    After you register, our cancellation terms apply. These can be found in our terms of delivery and in the national terms of deliveryFinally, we would like to point out that Bureau Klasse Kraamzorg handles your personal data correctly and according to the AVG, you can read this in our privacy regulations.