Information about the child
*First name:
Last Name:
*Date of birth (e.g. 01.02.2008):
*Mother tongue:
*Denomination:
*Family doctor (name and phone):
*Allergies / diseases:

	Who is the legal guardian?
	Please choose applicable
	Mother and father Mother Father If both, please select this field and fill in all the information about the mother and the father!
	Information about the mother
*First name:
*Last Name:
*Date of birth:
*Nationality:
*Address:
*Zip code / City:
*Private telephone:
*Business telephone:
*Telephone to get in contact:
**E-Mail to get in contact:
	Employer of the mother
*Company name:
*Address:
*Zip code / City:
*Telephone:
	New address if existing
*Address:
*Zip code / City:
	Information about the father
*First name:
*Last Name:
*Date of birth:
*Nationality:
*Address:
*Zip code / City:
*Private telephone:
*Business telephone:
*Telephone to get in contact:
*E-Mail to get in contact:
	Employer of the father
*Company name:
*Address:
*Zip code / City:
*Telephone:
	New address if existing
*Address:
*Zip code / City:

Explanation childcare participation and days
At least 20%, one whole day or two half days
Morning incl. lunch 06.30am to 13.00pm 15% (75% of the daily rate) Afternoon incl. lunch 11:30am to 06:30pm 15% (75% of the daily rate) Whole day 06.30am to 06.30pm 20% (100% of the daily rate)
Please enter your dates required
1st choice Morning Afternoon Whole day not applicable Monday Tuesday Wednesday Thursday Friday         2nd choice Morning Afternoon Whole day not applicable Monday Tuesday Wednesday Thursday Friday
	Entry date
*Desired entry date:
*Date of registration:
	Brothers and sisters
Name and year:
Name and year:
Name and year:
Name and year:
	Remarks Parents
Remarks Parents:

Non-binding fee classification
(please fill in a column per person)
Household income – for employed persons
Monthly income (Nettolohn II) according to wage statement	Fr.	Fr.
Pro-rata amount for the 13th monthly pay	Fr.	Fr.
Allowances (child/family allowances, bonuses, commissions, expenses, etc.)	Fr.	Fr.
Household income - for self-employed persons
Yearly income + 20% (at least CHF 24'000)	Fr.	Fr.
Further calculations – both income groups
Monthly incomes of alimony payments	Fr.	Fr.
Monthly deductions of alimony payments	Fr.	Fr.
Monthly replacement income (advance of payments, pensions, sickness/accident allowances, benefits of AHV)	Fr.	Fr.
Net assets according tax return (assets > 350'000 = max. rate, else 5% of net assets)	Fr.	Fr.
Monthly income
Total	Fr.	Fr.
Total für beide	Fr.
Overview fee classes
The overview table shows the assumed daily fee. The definite fee classification however will be calculated on the completation of contract.
Access to tax figures
(*please select)
Case 1: I/We pay the maximum fee of CHF 135.00 (CHF 148.50 baby place resp.) per day, do not hand in any income/assets documents and do not grant power of attorney to view tax figures. Case 2: I/We pay an income-related fee and grant power of attorney to view the tax figures (taxable income/assets according to the latest final assessment). The power of attorney expires as soon as the registration is withdrawn or the care contract is terminated.

*Health Insurance
I/We confirm, that our child has taken or will take out a health and accident insurance.
Name of health insurance:
*Important information
I/We confirm that all information given is truthful. I/We add copies of salary statement(s) / income documents in order to claim the income-related fee.
Place / date:

Contact: Ebru Yildiz, Nursery Manager, Wichtelhuus Day Nursery, Municipality of Unterägeri, Lidostrasse 32 / Schönenbühlstrasse 19, 6314 Unterägeri, Phone: 041 750 55 06/p>