Name parent *Address *Mobile phone *E-mail *Maximum 5 children each form. Do you want to sign-up more children? Fill-in this form several times! Amount of kids who are member of wijkvereniging Blixembosch € 5,00 Amount of kids who are not member of wijkvereniging Blixembosch € 10,00 Bedrag * € Totaal € Payment methode * iDEAL Hierbij geef ik toestemming om het terugkerende bedrag periodiek van mijn rekening te incasseren. First name child 1 *Surname child 1 *Gender child 1 *boygirlAge child 1 *012345678910Member Wijkvereniging Blixembosch child 1 *yesnoSubscribe child 1 in 1 word *First name child 2Surname child 2Gender child 2boygirlAge child 2012345678910Member Wijkvereniging Blixembosch child 2yesnoSubscribe child 2 in 1 wordFirst name child 3Surname child 3Gender child 3boygirlAge child 3012345678910Member Wijkvereniging Blixembosch child 3yesnoSubscribe child 3 in 1 wordFirst name child 4Surname child 4Gender child 4boygirlAge child 4012345678910Member Wijkvereniging Blixembosch child 4yesnoSubscribe child 4 in 1 wordFirst name child 5Surname child 5Gender child 5boygirlAge child 5012345678910Member Wijkvereniging Blixembosch child 5yesnoSubscribe child 5 in 1 wordCheck the number of members and non-members and the amount of children!?Sign upSign up