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Open Door Registration Form

Required *

Todays date

Mother's first name Mother's last name Mother's employment:

Father's first name Fathers last name Fathers's employment:

Family address (Street): Family address (City): Telephon nr.: Mobile nr.: E-mail address: Which Open Door activities would on the playgroup waiting list call 061-361-17-10, leave a clear message. The Playgroup Coordinator will call you

back. Children will only be registered on the waiting list when the membership fees are paid.

Name of your Child 1 *

Birthday of your child *

Sex of your child * F M

Name of your Child 2

Birthday of your child

Sex of your child F M

How did you find out about the Open Door? *

Membership Fee: A yearly membership costs CHF 65.-- and is renewed each1^st August.

Half-year membership is available to those who join after 1^st January and costs CHF 32.50.

Please indicate your selection below:

Membership Fee *

Please complete enclosed Giro form and pay your membership.

I Agree to the Terms and Conditions

Thank your, the open door committee.