{"id":396,"date":"2021-10-25T17:04:24","date_gmt":"2021-10-25T17:04:24","guid":{"rendered":"https:\/\/lassustandartsen.nl\/tilburg\/inschrijven\/"},"modified":"2025-03-13T15:11:59","modified_gmt":"2025-03-13T15:11:59","slug":"nieuwe-client","status":"publish","type":"page","link":"https:\/\/lassustandartsen.nl\/tilburg\/nieuwe-client\/","title":{"rendered":"Inschrijven"},"content":{"rendered":"\n<p>Onze praktijk staat open voor nieuwe cli\u00ebnten. U bent van harte welkom.<br>Wanneer u bij ons cli\u00ebnt wordt dan zult u merken dat een aantal zaken anders zullen verlopen dan u waarschijnlijk gewend bent.<\/p>\n\n\n\n<p>Bij uw eerste afspraak wordt er voor u 40 minuten gereserveerd. In die tijd willen wij met u kennis maken en vernemen wij graag uw tandheelkundige wensen en klachten. Ook nemen wij uw algemene gezondheid met u door.&nbsp;Er vindt een mondonderzoek plaats en er worden r\u00f6ntgen- en lichtfoto\u2019s gemaakt. De tandheelkundige gegevens en r\u00f6ntgenfoto\u2019s van uw vorige tandarts kunt u bij dit bezoek meenemen of aan ons op laten sturen.&nbsp;Na dit onderzoek bespreken wij de actuele toestand van uw gebit uitvoerig met u. Indien uw tandheelkundige situatie complexer is, dan maken wij voor deze bespreking een tweede afspraak met u.<\/p>\n\n\n\n<p>Tijdens uw eerste bezoek worden er geen behandeling gedaan tenzij u\u00a0<a href=\"https:\/\/lassustandartsen.nl\/tilburg\/spoed\/\">acute klachten<\/a>\u00a0heeft.<\/p>\n\n\n\n<p><\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"registration\">Inschrijfformulier<\/h2>\n\n\n<!-- HTML Forms v1.6.3 - https:\/\/wordpress.org\/plugins\/html-forms\/ -->\n<form method=\"post\"  class=\"hf-form hf-form-1636 \" data-id=\"1636\" data-title=\"Inschrijfformulier NL\" data-slug=\"inschrijfformulier-nieuwe-clienten\" data-message-success=\"Dank u! We nemen snel contact met je op.\" data-message-invalid-email=\"Sorry, dat e-mailadres lijkt ongeldig.\" data-message-required-field-missing=\"Gelieve de vereiste velden in te vullen.\" data-message-error=\"Oeps. Er is een fout opgetreden.\" data-message-recaptcha-failed=\"reCAPTCHA verification failed. Please try again.\" data-message-recaptcha-low-score=\"Your submission appears to be spam. Please try again.\" data-message-file-too-large=\"Uploaded file is too large.\" data-message-file-upload-error=\"An upload error occurred. Please try again later.\" data-message-submission-limit-reached=\"The submission limit for this form has been reached.\" data-message-require-user-logged-in=\"You must be logged in before you can use this form.\"><input type=\"hidden\" name=\"_hf_form_id\" value=\"1636\" \/><div style=\"display: none;\"><input type=\"text\" name=\"_hf_h1636\" value=\"\" \/><\/div><div class=\"hf-fields-wrap\"><div class=\"grid lg:grid-cols-2 gap-[30px] registration-form\">\r\n\r\n\t<div>\r\n\t\t<label for=\"first-name\" class=\"block mb-2\">Voornaam*<\/label>\r\n\t\t<input type=\"text\" name=\"first-name\" id=\"first-name\" placeholder=\"Vul uw voornaam in\" required=\"true\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t<\/div>\r\n\t<div>\r\n\t\t<label for=\"last-name\" class=\"block mb-2\">Achternaam*<\/label>\r\n\t\t<input type=\"text\" name=\"last-name\" id=\"last-name\" placeholder=\"Vul uw achternaam in\" required=\"true\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t<\/div>\r\n\r\n\t<div>\r\n\t\t<label for=\"birth-date\" class=\"block mb-2\">Geboortedatum*<\/label>\r\n\t\t<input type=\"date\" name=\"birth-date\" id=\"birth-date\" placeholder=\"Voer uw geboorte datum in\" required=\"true\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t<\/div>\r\n\t<div>\r\n\t\t<label for=\"gender\" class=\"block mb-2\">Geslacht*<\/label>\r\n\t\t<select type=\"date\" name=\"gender\" id=\"gender\" required=\"true\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t<option value=\"\">Selecteer<\/option>\t\r\n\t\t\t<option value=\"Man\">Man<\/option>\r\n\t\t\t<option value=\"Vrouw\">Vrouw<\/option>\r\n\t\t\t<option value=\"Ander\">Anders<\/option>\r\n\t\t<\/select>\r\n\t<\/div>\r\n\r\n\t<div>\r\n\t\t<label for=\"phone\" class=\"block mb-2\">Tel. mobiel*<\/label>\r\n\t\t<input type=\"tel\" name=\"phone\" id=\"phone\" placeholder=\"Vul je telefoonnummer in\" required=\"true\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t<\/div>\r\n\t<div>\r\n\t\t<label for=\"email\" class=\"block mb-2\">E-mailadres*<\/label>\r\n\t\t<input type=\"email\" name=\"email\" id=\"email\" placeholder=\"Vul je e-mailadres in\" required=\"true\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t<\/div>\r\n\r\n\r\n\t<div class=\"lg:col-span-2 grid\">\r\n\t\t<section class=\"mt-14 pt-14 border-t border-[#E5E5E5] child child-1\">\r\n\t\t\t<div class=\"grid lg:grid-cols-2 gap-[30px]\">\r\n\t\t\t\t<div class=\"lg:col-span-2 flex justify-between items-center\">\r\n\t\t\t\t\t<div class=\"text-xl uppercase font-title\">\r\n\t\t\t\t\t\t<p class=\"!mb-0\">familielid (kind)<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"text-right\">\r\n\t\t\t\t\t\t<div class=\"removeChild cursor-pointer bg-primary text-white w-10 h-10 rounded-full inline-flex items-center justify-center transform hover:scale-105 transition duration-200\">\r\n\t\t\t\t\t\t\t<svg width=\"13\" height=\"13\" viewBox=\"0 0 13 13\" fill=\"none\" >\r\n\t\t\t\t\t\t\t\t<path d=\"M7.82812 6.5L12.6719 11.3438C12.7109 11.4219 12.75 11.5 12.75 11.5781C12.75 11.6562 12.7109 11.7344 12.6719 11.7734L11.7734 12.6719C11.6953 12.75 11.6172 12.75 11.5391 12.75C11.4609 12.75 11.3828 12.75 11.3438 12.6719L6.5 7.82812L1.65625 12.6719C1.57812 12.75 1.5 12.75 1.42188 12.75C1.34375 12.75 1.26562 12.75 1.22656 12.6719L0.328125 11.7734C0.25 11.7344 0.25 11.6562 0.25 11.5781C0.25 11.5 0.25 11.4219 0.328125 11.3438L5.17188 6.5L0.328125 1.65625C0.25 1.61719 0.25 1.53906 0.25 1.46094C0.25 1.38281 0.25 1.30469 0.328125 1.22656L1.22656 0.328125C1.26562 0.289062 1.34375 0.25 1.42188 0.25C1.5 0.25 1.57812 0.289062 1.65625 0.328125L6.5 5.17188L11.3438 0.328125C11.3828 0.289062 11.4609 0.25 11.5391 0.25C11.6172 0.25 11.6953 0.289062 11.7734 0.328125L12.6719 1.22656C12.7109 1.30469 12.75 1.38281 12.75 1.46094C12.75 1.53906 12.7109 1.61719 12.6719 1.65625L11.8516 2.47656L7.82812 6.5Z\" fill=\"currentColor\"\/>\r\n\t\t\t\t\t\t\t<\/svg>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"first-name-child-1\" class=\"block mb-2\">Voornaam*<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"first-name-child-1\" id=\"first-name-child-1\" placeholder=\"Vul uw voornaam in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"last-name-child-1\" class=\"block mb-2\">Achternaam*<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"last-name-child-1\" id=\"last-name-child-1\" placeholder=\"Vul uw achternaam in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"birth-date-child-1\" class=\"block mb-2\">Geboortedatum*<\/label>\r\n\t\t\t\t\t<input type=\"date\" name=\"birth-date-child-1\" id=\"birth-date-child-1\" placeholder=\"Voer uw geboortedatum in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"gender-child-1\" class=\"block mb-2\">Geslacht*<\/label>\r\n\t\t\t\t\t<select type=\"date\" name=\"gender-child-1\" id=\"gender-child-1\" placeholder=\"Gender\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t\t\t<option value=\"\">Selecteereer<\/option>\t\r\n\t\t\t\t\t\t<option value=\"Man\">Man<\/option>\r\n\t\t\t\t\t\t<option value=\"Vrouw\">Vrouw<\/option>\r\n\t\t\t\t\t\t<option value=\"Ander\">Anders<\/option>\r\n\t\t\t\t\t<\/select>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\t\t<\/section>\r\n\r\n\t\t<section class=\"mt-14 pt-14 border-t border-[#E5E5E5] child child-2\">\r\n\t\t\t<div class=\"grid lg:grid-cols-2 gap-[30px]\">\r\n\t\t\t\t<div class=\"lg:col-span-2 flex justify-between items-center\">\r\n\t\t\t\t\t<div class=\"text-xl uppercase font-title\">\r\n\t\t\t\t\t\t<p class=\"!mb-0\">familielid (kind)<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"text-right\">\r\n\t\t\t\t\t\t<div class=\"removeChild cursor-pointer bg-primary text-white w-10 h-10 rounded-full inline-flex items-center justify-center transform hover:scale-105 transition duration-200\">\r\n\t\t\t\t\t\t\t<svg width=\"13\" height=\"13\" viewBox=\"0 0 13 13\" fill=\"none\" >\r\n\t\t\t\t\t\t\t\t<path d=\"M7.82812 6.5L12.6719 11.3438C12.7109 11.4219 12.75 11.5 12.75 11.5781C12.75 11.6562 12.7109 11.7344 12.6719 11.7734L11.7734 12.6719C11.6953 12.75 11.6172 12.75 11.5391 12.75C11.4609 12.75 11.3828 12.75 11.3438 12.6719L6.5 7.82812L1.65625 12.6719C1.57812 12.75 1.5 12.75 1.42188 12.75C1.34375 12.75 1.26562 12.75 1.22656 12.6719L0.328125 11.7734C0.25 11.7344 0.25 11.6562 0.25 11.5781C0.25 11.5 0.25 11.4219 0.328125 11.3438L5.17188 6.5L0.328125 1.65625C0.25 1.61719 0.25 1.53906 0.25 1.46094C0.25 1.38281 0.25 1.30469 0.328125 1.22656L1.22656 0.328125C1.26562 0.289062 1.34375 0.25 1.42188 0.25C1.5 0.25 1.57812 0.289062 1.65625 0.328125L6.5 5.17188L11.3438 0.328125C11.3828 0.289062 11.4609 0.25 11.5391 0.25C11.6172 0.25 11.6953 0.289062 11.7734 0.328125L12.6719 1.22656C12.7109 1.30469 12.75 1.38281 12.75 1.46094C12.75 1.53906 12.7109 1.61719 12.6719 1.65625L11.8516 2.47656L7.82812 6.5Z\" fill=\"currentColor\"\/>\r\n\t\t\t\t\t\t\t<\/svg>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"first-name-child-2\" class=\"block mb-2\">Voornaam*<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"first-name-child-2\" id=\"first-name-child-2\" placeholder=\"Vul de voornaam in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"last-name-child-2\" class=\"block mb-2\">Achternaam*<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"last-name-child-2\" id=\"last-name-child-2\" placeholder=\"Vul de achternaam in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"birth-date-child-2\" class=\"block mb-2\">Geboortedatum*<\/label>\r\n\t\t\t\t\t<input type=\"date\" name=\"birth-date-child-2\" id=\"birth-date-child-2\" placeholder=\"Voer de geboortedatum in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"gender-child-2\" class=\"block mb-2\">Geslacht*<\/label>\r\n\t\t\t\t\t<select type=\"date\" name=\"gender-child-2\" id=\"gender-child-2\" placeholder=\"Gender\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t\t\t<option value=\"\">Selecteer<\/option>\t\r\n\t\t\t\t\t\t<option value=\"Man\">Man<\/option>\r\n\t\t\t\t\t\t<option value=\"Vrouw\">Vrouw<\/option>\r\n\t\t\t\t\t\t<option value=\"Ander\">Anders<\/option>\r\n\t\t\t\t\t<\/select>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\t\t<\/section>\r\n\r\n\t\t<section class=\"mt-14 pt-14 border-t border-[#E5E5E5] child child-3\">\r\n\t\t\t<div class=\"grid lg:grid-cols-2 gap-[30px]\">\r\n\t\t\t\t<div class=\"lg:col-span-2 flex justify-between items-center\">\r\n\t\t\t\t\t<div class=\"text-xl uppercase font-title\">\r\n\t\t\t\t\t\t<p class=\"!mb-0\">familielid (kind)<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"text-right\">\r\n\t\t\t\t\t\t<div class=\"removeChild cursor-pointer bg-primary text-white w-10 h-10 rounded-full inline-flex items-center justify-center transform hover:scale-105 transition duration-200\">\r\n\t\t\t\t\t\t\t<svg width=\"13\" height=\"13\" viewBox=\"0 0 13 13\" fill=\"none\" >\r\n\t\t\t\t\t\t\t\t<path d=\"M7.82812 6.5L12.6719 11.3438C12.7109 11.4219 12.75 11.5 12.75 11.5781C12.75 11.6562 12.7109 11.7344 12.6719 11.7734L11.7734 12.6719C11.6953 12.75 11.6172 12.75 11.5391 12.75C11.4609 12.75 11.3828 12.75 11.3438 12.6719L6.5 7.82812L1.65625 12.6719C1.57812 12.75 1.5 12.75 1.42188 12.75C1.34375 12.75 1.26562 12.75 1.22656 12.6719L0.328125 11.7734C0.25 11.7344 0.25 11.6562 0.25 11.5781C0.25 11.5 0.25 11.4219 0.328125 11.3438L5.17188 6.5L0.328125 1.65625C0.25 1.61719 0.25 1.53906 0.25 1.46094C0.25 1.38281 0.25 1.30469 0.328125 1.22656L1.22656 0.328125C1.26562 0.289062 1.34375 0.25 1.42188 0.25C1.5 0.25 1.57812 0.289062 1.65625 0.328125L6.5 5.17188L11.3438 0.328125C11.3828 0.289062 11.4609 0.25 11.5391 0.25C11.6172 0.25 11.6953 0.289062 11.7734 0.328125L12.6719 1.22656C12.7109 1.30469 12.75 1.38281 12.75 1.46094C12.75 1.53906 12.7109 1.61719 12.6719 1.65625L11.8516 2.47656L7.82812 6.5Z\" fill=\"currentColor\"\/>\r\n\t\t\t\t\t\t\t<\/svg>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"first-name-child-3\" class=\"block mb-2\">Voornaam*<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"first-name-child-3\" id=\"first-name-child-3\" placeholder=\"Vul uw voornaam in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"last-name-child-3\" class=\"block mb-2\">Achternaam*<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"last-name-child-3\" id=\"last-name-child-3\" placeholder=\"Vul je achternaam in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"birth-date-child-3\" class=\"block mb-2\">Geboortedatum*<\/label>\r\n\t\t\t\t\t<input type=\"date\" name=\"birth-date-child-3\" id=\"birth-date-child-3\" placeholder=\"Voer je geboorte datum in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"gender-child-3\" class=\"block mb-2\">Geslacht*<\/label>\r\n\t\t\t\t\t<select type=\"date\" name=\"gender-child-3\" id=\"gender-child-3\" placeholder=\"Gender\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t\t\t<option value=\"\">Selecteer<\/option>\t\r\n\t\t\t\t\t\t<option value=\"Man\">Man<\/option>\r\n\t\t\t\t\t\t<option value=\"Vrouw\">Vrouw<\/option>\r\n\t\t\t\t\t\t<option value=\"Ander\">Ander<\/option>\r\n\t\t\t\t\t<\/select>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\t\t<\/section>\r\n\r\n\t\t<section class=\"mt-14 pt-14 border-t border-[#E5E5E5] child child-4\">\r\n\t\t\t<div class=\"grid lg:grid-cols-2 gap-[30px]\">\r\n\t\t\t\t<div class=\"lg:col-span-2 flex justify-between items-center\">\r\n\t\t\t\t\t<div class=\"text-xl uppercase font-title\">\r\n\t\t\t\t\t\t<p class=\"!mb-0\">familielid (kind)<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"text-right\">\r\n\t\t\t\t\t\t<div class=\"removeChild cursor-pointer bg-primary text-white w-10 h-10 rounded-full inline-flex items-center justify-center transform hover:scale-105 transition duration-200\">\r\n\t\t\t\t\t\t\t<svg width=\"13\" height=\"13\" viewBox=\"0 0 13 13\" fill=\"none\" >\r\n\t\t\t\t\t\t\t\t<path d=\"M7.82812 6.5L12.6719 11.3438C12.7109 11.4219 12.75 11.5 12.75 11.5781C12.75 11.6562 12.7109 11.7344 12.6719 11.7734L11.7734 12.6719C11.6953 12.75 11.6172 12.75 11.5391 12.75C11.4609 12.75 11.3828 12.75 11.3438 12.6719L6.5 7.82812L1.65625 12.6719C1.57812 12.75 1.5 12.75 1.42188 12.75C1.34375 12.75 1.26562 12.75 1.22656 12.6719L0.328125 11.7734C0.25 11.7344 0.25 11.6562 0.25 11.5781C0.25 11.5 0.25 11.4219 0.328125 11.3438L5.17188 6.5L0.328125 1.65625C0.25 1.61719 0.25 1.53906 0.25 1.46094C0.25 1.38281 0.25 1.30469 0.328125 1.22656L1.22656 0.328125C1.26562 0.289062 1.34375 0.25 1.42188 0.25C1.5 0.25 1.57812 0.289062 1.65625 0.328125L6.5 5.17188L11.3438 0.328125C11.3828 0.289062 11.4609 0.25 11.5391 0.25C11.6172 0.25 11.6953 0.289062 11.7734 0.328125L12.6719 1.22656C12.7109 1.30469 12.75 1.38281 12.75 1.46094C12.75 1.53906 12.7109 1.61719 12.6719 1.65625L11.8516 2.47656L7.82812 6.5Z\" fill=\"currentColor\"\/>\r\n\t\t\t\t\t\t\t<\/svg>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"first-name-child-4\" class=\"block mb-2\">Voornaam*<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"first-name-child-4\" id=\"first-name-child-4\" placeholder=\"Vul uw voornaam in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"last-name-child-4\" class=\"block mb-2\">Achternaam*<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"last-name-child-4\" id=\"last-name-child-4\" placeholder=\"Vul je achternaam in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"birth-date-child-4\" class=\"block mb-2\">Geboortedatum*<\/label>\r\n\t\t\t\t\t<input type=\"date\" name=\"birth-date-child-4\" id=\"birth-date-child-4\" placeholder=\"Voer je geboorte datum in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"gender-child-4\" class=\"block mb-2\">Geslacht*<\/label>\r\n\t\t\t\t\t<select type=\"date\" name=\"gender-child-4\" id=\"gender-child-4\" placeholder=\"Gender\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t\t\t<option value=\"\">Selecteereer<\/option>\t\r\n\t\t\t\t\t\t<option value=\"Man\">Man<\/option>\r\n\t\t\t\t\t\t<option value=\"Vrouw\">Vrouw<\/option>\r\n\t\t\t\t\t\t<option value=\"Ander\">Ander<\/option>\r\n\t\t\t\t\t<\/select>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\t\t<\/section>\r\n\r\n\t\t<section class=\"mt-14 pt-14 border-t border-[#E5E5E5] child child-5\">\r\n\t\t\t<div class=\"grid lg:grid-cols-2 gap-[30px]\">\r\n\t\t\t\t<div class=\"lg:col-span-2 flex justify-between items-center\">\r\n\t\t\t\t\t<div class=\"text-xl uppercase font-title\">\r\n\t\t\t\t\t\t<p class=\"!mb-0\">familielid (kind)<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"text-right\">\r\n\t\t\t\t\t\t<div class=\"removeChild cursor-pointer bg-primary text-white w-10 h-10 rounded-full inline-flex items-center justify-center transform hover:scale-105 transition duration-200\">\r\n\t\t\t\t\t\t\t<svg width=\"13\" height=\"13\" viewBox=\"0 0 13 13\" fill=\"none\" >\r\n\t\t\t\t\t\t\t\t<path d=\"M7.82812 6.5L12.6719 11.3438C12.7109 11.4219 12.75 11.5 12.75 11.5781C12.75 11.6562 12.7109 11.7344 12.6719 11.7734L11.7734 12.6719C11.6953 12.75 11.6172 12.75 11.5391 12.75C11.4609 12.75 11.3828 12.75 11.3438 12.6719L6.5 7.82812L1.65625 12.6719C1.57812 12.75 1.5 12.75 1.42188 12.75C1.34375 12.75 1.26562 12.75 1.22656 12.6719L0.328125 11.7734C0.25 11.7344 0.25 11.6562 0.25 11.5781C0.25 11.5 0.25 11.4219 0.328125 11.3438L5.17188 6.5L0.328125 1.65625C0.25 1.61719 0.25 1.53906 0.25 1.46094C0.25 1.38281 0.25 1.30469 0.328125 1.22656L1.22656 0.328125C1.26562 0.289062 1.34375 0.25 1.42188 0.25C1.5 0.25 1.57812 0.289062 1.65625 0.328125L6.5 5.17188L11.3438 0.328125C11.3828 0.289062 11.4609 0.25 11.5391 0.25C11.6172 0.25 11.6953 0.289062 11.7734 0.328125L12.6719 1.22656C12.7109 1.30469 12.75 1.38281 12.75 1.46094C12.75 1.53906 12.7109 1.61719 12.6719 1.65625L11.8516 2.47656L7.82812 6.5Z\" fill=\"currentColor\"\/>\r\n\t\t\t\t\t\t\t<\/svg>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"first-name-child-5\" class=\"block mb-2\">Voornaam*<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"first-name-child-5\" id=\"first-name-child-5\" placeholder=\"Vul uw voornaam in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"last-name-child-5\" class=\"block mb-2\">Achternaam*<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"last-name-child-5\" id=\"last-name-child-5\" placeholder=\"Vul je achternaam in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"birth-date-child-5\" class=\"block mb-2\">Geboortedatum*<\/label>\r\n\t\t\t\t\t<input type=\"date\" name=\"birth-date-child-5\" id=\"birth-date-child-5\" placeholder=\"Voer je geboorte datum in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"gender-child-5\" class=\"block mb-2\">Geslacht*<\/label>\r\n\t\t\t\t\t<select type=\"date\" name=\"gender-child-5\" id=\"gender-child-5\" placeholder=\"Gender\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t\t\t<option value=\"\">Selecteer<\/option>\t\r\n\t\t\t\t\t\t<option value=\"Man\">Man<\/option>\r\n\t\t\t\t\t\t<option value=\"Vrouw\">Vrouw<\/option>\r\n\t\t\t\t\t\t<option value=\"Ander\">Ander<\/option>\r\n\t\t\t\t\t<\/select>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\t\t<\/section>\r\n\r\n\t\t\r\n\t\t<section class=\"mt-14 pt-14 border-t border-[#E5E5E5] adult adult-1\">\r\n\t\t\t<div class=\"grid lg:grid-cols-2 gap-[30px]\">\r\n\t\t\t\t<div class=\"lg:col-span-2 flex justify-between items-center\">\r\n\t\t\t\t\t<div class=\"text-xl uppercase font-title\">\r\n\t\t\t\t\t\t<p class=\"!mb-0\">gezinslid (volwassene)<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"text-right\">\r\n\t\t\t\t\t\t<div class=\"removeAdult cursor-pointer bg-primary text-white w-10 h-10 rounded-full inline-flex items-center justify-center transform hover:scale-105 transition duration-200\">\r\n\t\t\t\t\t\t\t<svg width=\"13\" height=\"13\" viewBox=\"0 0 13 13\" fill=\"none\" >\r\n\t\t\t\t\t\t\t\t<path d=\"M7.82812 6.5L12.6719 11.3438C12.7109 11.4219 12.75 11.5 12.75 11.5781C12.75 11.6562 12.7109 11.7344 12.6719 11.7734L11.7734 12.6719C11.6953 12.75 11.6172 12.75 11.5391 12.75C11.4609 12.75 11.3828 12.75 11.3438 12.6719L6.5 7.82812L1.65625 12.6719C1.57812 12.75 1.5 12.75 1.42188 12.75C1.34375 12.75 1.26562 12.75 1.22656 12.6719L0.328125 11.7734C0.25 11.7344 0.25 11.6562 0.25 11.5781C0.25 11.5 0.25 11.4219 0.328125 11.3438L5.17188 6.5L0.328125 1.65625C0.25 1.61719 0.25 1.53906 0.25 1.46094C0.25 1.38281 0.25 1.30469 0.328125 1.22656L1.22656 0.328125C1.26562 0.289062 1.34375 0.25 1.42188 0.25C1.5 0.25 1.57812 0.289062 1.65625 0.328125L6.5 5.17188L11.3438 0.328125C11.3828 0.289062 11.4609 0.25 11.5391 0.25C11.6172 0.25 11.6953 0.289062 11.7734 0.328125L12.6719 1.22656C12.7109 1.30469 12.75 1.38281 12.75 1.46094C12.75 1.53906 12.7109 1.61719 12.6719 1.65625L11.8516 2.47656L7.82812 6.5Z\" fill=\"currentColor\"\/>\r\n\t\t\t\t\t\t\t<\/svg>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"first-name-adult-1\" class=\"block mb-2\">Voornaam*<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"first-name-adult-1\" id=\"first-name-adult-1\" placeholder=\"Vul uw voornaam in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"last-name-adult-1\" class=\"block mb-2\">Achternaam*<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"last-name-adult-1\" id=\"last-name-adult-1\" placeholder=\"Vul je achternaam in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"birth-date-adult-1\" class=\"block mb-2\">Geboortedatum*<\/label>\r\n\t\t\t\t\t<input type=\"date\" name=\"birth-date-adult-1\" id=\"birth-date-adult-1\" placeholder=\"Voer je geboorte datum in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"gender-adult-1\" class=\"block mb-2\">Geslacht*<\/label>\r\n\t\t\t\t\t<select type=\"date\" name=\"gender-adult-1\" id=\"gender-adult-1\" placeholder=\"Gender\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t\t\t<option value=\"\">Selecteer<\/option>\t\r\n\t\t\t\t\t\t<option value=\"Man\">Man<\/option>\r\n\t\t\t\t\t\t<option value=\"Vrouw\">Vrouw<\/option>\r\n\t\t\t\t\t\t<option value=\"Ander\">Ander<\/option>\r\n\t\t\t\t\t<\/select>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"phone-adult-1\" class=\"block mb-2\">Tel. mobiel*<\/label>\r\n\t\t\t\t\t<input type=\"tel\" name=\"phone-adult-1\" id=\"phone-adult-1\" placeholder=\"Enter your phone number\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"email-adult-1\" class=\"block mb-2\">E-mailadres*<\/label>\r\n\t\t\t\t\t<input type=\"email\" name=\"email-adult-1\" id=\"email-adult-1\" placeholder=\"Enter your email\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\t\t<\/section>\r\n\r\n\t\t<section class=\"mt-14 pt-14 border-t border-[#E5E5E5] adult adult-2\">\r\n\t\t\t<div class=\"grid lg:grid-cols-2 gap-[30px]\">\r\n\t\t\t\t<div class=\"lg:col-span-2 flex justify-between items-center\">\r\n\t\t\t\t\t<div class=\"text-xl uppercase font-title\">\r\n\t\t\t\t\t\t<p class=\"!mb-0\">gezinslid (volwassene)<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"text-right\">\r\n\t\t\t\t\t\t<div class=\"removeAdult cursor-pointer bg-primary text-white w-10 h-10 rounded-full inline-flex items-center justify-center transform hover:scale-105 transition duration-200\">\r\n\t\t\t\t\t\t\t<svg width=\"13\" height=\"13\" viewBox=\"0 0 13 13\" fill=\"none\" >\r\n\t\t\t\t\t\t\t\t<path d=\"M7.82812 6.5L12.6719 11.3438C12.7109 11.4219 12.75 11.5 12.75 11.5781C12.75 11.6562 12.7109 11.7344 12.6719 11.7734L11.7734 12.6719C11.6953 12.75 11.6172 12.75 11.5391 12.75C11.4609 12.75 11.3828 12.75 11.3438 12.6719L6.5 7.82812L1.65625 12.6719C1.57812 12.75 1.5 12.75 1.42188 12.75C1.34375 12.75 1.26562 12.75 1.22656 12.6719L0.328125 11.7734C0.25 11.7344 0.25 11.6562 0.25 11.5781C0.25 11.5 0.25 11.4219 0.328125 11.3438L5.17188 6.5L0.328125 1.65625C0.25 1.61719 0.25 1.53906 0.25 1.46094C0.25 1.38281 0.25 1.30469 0.328125 1.22656L1.22656 0.328125C1.26562 0.289062 1.34375 0.25 1.42188 0.25C1.5 0.25 1.57812 0.289062 1.65625 0.328125L6.5 5.17188L11.3438 0.328125C11.3828 0.289062 11.4609 0.25 11.5391 0.25C11.6172 0.25 11.6953 0.289062 11.7734 0.328125L12.6719 1.22656C12.7109 1.30469 12.75 1.38281 12.75 1.46094C12.75 1.53906 12.7109 1.61719 12.6719 1.65625L11.8516 2.47656L7.82812 6.5Z\" fill=\"currentColor\"\/>\r\n\t\t\t\t\t\t\t<\/svg>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"first-name-adult-2\" class=\"block mb-2\">Voornaam*<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"first-name-adult-2\" id=\"first-name-adult-2\" placeholder=\"Vul uw voornaam in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"last-name-adult-2\" class=\"block mb-2\">Achternaam*<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"last-name-adult-2\" id=\"last-name-adult-2\" placeholder=\"Vul je achternaam in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"birth-date-adult-2\" class=\"block mb-2\">Geboortedatum*<\/label>\r\n\t\t\t\t\t<input type=\"date\" name=\"birth-date-adult-2\" id=\"birth-date-adult-2\" placeholder=\"Voer je geboorte datum in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"gender-adult-2\" class=\"block mb-2\">Geslacht*<\/label>\r\n\t\t\t\t\t<select type=\"date\" name=\"gender-adult-2\" id=\"gender-adult-2\" placeholder=\"Gender\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t\t\t<option value=\"\">Selecteer<\/option>\t\r\n\t\t\t\t\t\t<option value=\"Man\">Man<\/option>\r\n\t\t\t\t\t\t<option value=\"Vrouw\">Vrouw<\/option>\r\n\t\t\t\t\t\t<option value=\"Ander\">Ander<\/option>\r\n\t\t\t\t\t<\/select>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"phone-adult-2\" class=\"block mb-2\">Tel. mobiel*<\/label>\r\n\t\t\t\t\t<input type=\"tel\" name=\"phone-adult-2\" id=\"phone-adult-2\" placeholder=\"Enter your phone number\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"email-adult-2\" class=\"block mb-2\">E-mailadres*<\/label>\r\n\t\t\t\t\t<input type=\"email\" name=\"email-adult-2\" id=\"email-adult-2\" placeholder=\"Enter your email\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\t\t<\/section>\r\n\r\n\t\t<section class=\"mt-14 pt-14 border-t border-[#E5E5E5] adult adult-3\">\r\n\t\t\t<div class=\"grid lg:grid-cols-2 gap-[30px]\">\r\n\t\t\t\t<div class=\"lg:col-span-2 flex justify-between items-center\">\r\n\t\t\t\t\t<div class=\"text-xl uppercase font-title\">\r\n\t\t\t\t\t\t<p class=\"!mb-0\">gezinslid (volwassene)<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"text-right\">\r\n\t\t\t\t\t\t<div class=\"removeAdult cursor-pointer bg-primary text-white w-10 h-10 rounded-full inline-flex items-center justify-center transform hover:scale-105 transition duration-200\">\r\n\t\t\t\t\t\t\t<svg width=\"13\" height=\"13\" viewBox=\"0 0 13 13\" fill=\"none\" >\r\n\t\t\t\t\t\t\t\t<path d=\"M7.82812 6.5L12.6719 11.3438C12.7109 11.4219 12.75 11.5 12.75 11.5781C12.75 11.6562 12.7109 11.7344 12.6719 11.7734L11.7734 12.6719C11.6953 12.75 11.6172 12.75 11.5391 12.75C11.4609 12.75 11.3828 12.75 11.3438 12.6719L6.5 7.82812L1.65625 12.6719C1.57812 12.75 1.5 12.75 1.42188 12.75C1.34375 12.75 1.26562 12.75 1.22656 12.6719L0.328125 11.7734C0.25 11.7344 0.25 11.6562 0.25 11.5781C0.25 11.5 0.25 11.4219 0.328125 11.3438L5.17188 6.5L0.328125 1.65625C0.25 1.61719 0.25 1.53906 0.25 1.46094C0.25 1.38281 0.25 1.30469 0.328125 1.22656L1.22656 0.328125C1.26562 0.289062 1.34375 0.25 1.42188 0.25C1.5 0.25 1.57812 0.289062 1.65625 0.328125L6.5 5.17188L11.3438 0.328125C11.3828 0.289062 11.4609 0.25 11.5391 0.25C11.6172 0.25 11.6953 0.289062 11.7734 0.328125L12.6719 1.22656C12.7109 1.30469 12.75 1.38281 12.75 1.46094C12.75 1.53906 12.7109 1.61719 12.6719 1.65625L11.8516 2.47656L7.82812 6.5Z\" fill=\"currentColor\"\/>\r\n\t\t\t\t\t\t\t<\/svg>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"first-name-adult-3\" class=\"block mb-2\">Voornaam*<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"first-name-adult-3\" id=\"first-name-adult-3\" placeholder=\"Vul uw voornaam in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"last-name-adult-3\" class=\"block mb-2\">Achternaam*<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"last-name-adult-3\" id=\"last-name-adult-3\" placeholder=\"Vul je achternaam in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"birth-date-adult-3\" class=\"block mb-2\">Geboortedatum*<\/label>\r\n\t\t\t\t\t<input type=\"date\" name=\"birth-date-adult-3\" id=\"birth-date-adult-3\" placeholder=\"Voer je geboorte datum in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"gender-adult-3\" class=\"block mb-2\">Geslacht*<\/label>\r\n\t\t\t\t\t<select type=\"date\" name=\"gender-adult-3\" id=\"gender-adult-3\" placeholder=\"Gender\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t\t\t<option value=\"\">Selecteer<\/option>\t\r\n\t\t\t\t\t\t<option value=\"Man\">Man<\/option>\r\n\t\t\t\t\t\t<option value=\"Vrouw\">Vrouw<\/option>\r\n\t\t\t\t\t\t<option value=\"Ander\">Ander<\/option>\r\n\t\t\t\t\t<\/select>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"phone-adult-3\" class=\"block mb-2\">Tel. mobiel*<\/label>\r\n\t\t\t\t\t<input type=\"tel\" name=\"phone-adult-3\" id=\"phone-adult-3\" placeholder=\"Enter your phone number\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"email-adult-3\" class=\"block mb-2\">E-mailadres*<\/label>\r\n\t\t\t\t\t<input type=\"email\" name=\"email-adult-3\" id=\"email-adult-3\" placeholder=\"Enter your email\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\t\t<\/section>\r\n\r\n\t\t<section class=\"mt-14 pt-14 border-t border-[#E5E5E5] adult adult-4\">\r\n\t\t\t<div class=\"grid lg:grid-cols-2 gap-[30px]\">\r\n\t\t\t\t<div class=\"lg:col-span-2 flex justify-between items-center\">\r\n\t\t\t\t\t<div class=\"text-xl uppercase font-title\">\r\n\t\t\t\t\t\t<p class=\"!mb-0\">gezinslid (volwassene)<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"text-right\">\r\n\t\t\t\t\t\t<div class=\"removeAdult cursor-pointer bg-primary text-white w-10 h-10 rounded-full inline-flex items-center justify-center transform hover:scale-105 transition duration-200\">\r\n\t\t\t\t\t\t\t<svg width=\"13\" height=\"13\" viewBox=\"0 0 13 13\" fill=\"none\" >\r\n\t\t\t\t\t\t\t\t<path d=\"M7.82812 6.5L12.6719 11.3438C12.7109 11.4219 12.75 11.5 12.75 11.5781C12.75 11.6562 12.7109 11.7344 12.6719 11.7734L11.7734 12.6719C11.6953 12.75 11.6172 12.75 11.5391 12.75C11.4609 12.75 11.3828 12.75 11.3438 12.6719L6.5 7.82812L1.65625 12.6719C1.57812 12.75 1.5 12.75 1.42188 12.75C1.34375 12.75 1.26562 12.75 1.22656 12.6719L0.328125 11.7734C0.25 11.7344 0.25 11.6562 0.25 11.5781C0.25 11.5 0.25 11.4219 0.328125 11.3438L5.17188 6.5L0.328125 1.65625C0.25 1.61719 0.25 1.53906 0.25 1.46094C0.25 1.38281 0.25 1.30469 0.328125 1.22656L1.22656 0.328125C1.26562 0.289062 1.34375 0.25 1.42188 0.25C1.5 0.25 1.57812 0.289062 1.65625 0.328125L6.5 5.17188L11.3438 0.328125C11.3828 0.289062 11.4609 0.25 11.5391 0.25C11.6172 0.25 11.6953 0.289062 11.7734 0.328125L12.6719 1.22656C12.7109 1.30469 12.75 1.38281 12.75 1.46094C12.75 1.53906 12.7109 1.61719 12.6719 1.65625L11.8516 2.47656L7.82812 6.5Z\" fill=\"currentColor\"\/>\r\n\t\t\t\t\t\t\t<\/svg>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"first-name-adult-4\" class=\"block mb-2\">Voornaam*<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"first-name-adult-4\" id=\"first-name-adult-4\" placeholder=\"Vul uw voornaam in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"last-name-adult-4\" class=\"block mb-2\">Achternaam*<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"last-name-adult-4\" id=\"last-name-adult-4\" placeholder=\"Vul je achternaam in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"birth-date-adult-4\" class=\"block mb-2\">Geboortedatum*<\/label>\r\n\t\t\t\t\t<input type=\"date\" name=\"birth-date-adult-4\" id=\"birth-date-adult-4\" placeholder=\"Voer je geboorte datum in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"gender-adult-4\" class=\"block mb-2\">Geslacht*<\/label>\r\n\t\t\t\t\t<select type=\"date\" name=\"gender-adult-4\" id=\"gender-adult-4\" placeholder=\"Gender\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t\t\t<option value=\"\">Selecteer<\/option>\t\r\n\t\t\t\t\t\t<option value=\"Man\">Man<\/option>\r\n\t\t\t\t\t\t<option value=\"Vrouw\">Vrouw<\/option>\r\n\t\t\t\t\t\t<option value=\"Ander\">Ander<\/option>\r\n\t\t\t\t\t<\/select>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"phone-adult-4\" class=\"block mb-2\">Tel. mobiel*<\/label>\r\n\t\t\t\t\t<input type=\"tel\" name=\"phone-adult-4\" id=\"phone-adult-4\" placeholder=\"Enter your phone number\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"email-adult-4\" class=\"block mb-2\">E-mailadres*<\/label>\r\n\t\t\t\t\t<input type=\"email\" name=\"email-adult-4\" id=\"email-adult-4\" placeholder=\"Enter your email\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\t\t<\/section>\r\n\r\n\t\t<section class=\"mt-14 pt-14 border-t border-[#E5E5E5] adult adult-5\">\r\n\t\t\t<div class=\"grid lg:grid-cols-2 gap-[30px]\">\r\n\t\t\t\t<div class=\"lg:col-span-2 flex justify-between items-center\">\r\n\t\t\t\t\t<div class=\"text-xl uppercase font-title\">\r\n\t\t\t\t\t\t<p class=\"!mb-0\">gezinslid (volwassene)<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"text-right\">\r\n\t\t\t\t\t\t<div class=\"removeAdult cursor-pointer bg-primary text-white w-10 h-10 rounded-full inline-flex items-center justify-center transform hover:scale-105 transition duration-200\">\r\n\t\t\t\t\t\t\t<svg width=\"13\" height=\"13\" viewBox=\"0 0 13 13\" fill=\"none\" >\r\n\t\t\t\t\t\t\t\t<path d=\"M7.82812 6.5L12.6719 11.3438C12.7109 11.4219 12.75 11.5 12.75 11.5781C12.75 11.6562 12.7109 11.7344 12.6719 11.7734L11.7734 12.6719C11.6953 12.75 11.6172 12.75 11.5391 12.75C11.4609 12.75 11.3828 12.75 11.3438 12.6719L6.5 7.82812L1.65625 12.6719C1.57812 12.75 1.5 12.75 1.42188 12.75C1.34375 12.75 1.26562 12.75 1.22656 12.6719L0.328125 11.7734C0.25 11.7344 0.25 11.6562 0.25 11.5781C0.25 11.5 0.25 11.4219 0.328125 11.3438L5.17188 6.5L0.328125 1.65625C0.25 1.61719 0.25 1.53906 0.25 1.46094C0.25 1.38281 0.25 1.30469 0.328125 1.22656L1.22656 0.328125C1.26562 0.289062 1.34375 0.25 1.42188 0.25C1.5 0.25 1.57812 0.289062 1.65625 0.328125L6.5 5.17188L11.3438 0.328125C11.3828 0.289062 11.4609 0.25 11.5391 0.25C11.6172 0.25 11.6953 0.289062 11.7734 0.328125L12.6719 1.22656C12.7109 1.30469 12.75 1.38281 12.75 1.46094C12.75 1.53906 12.7109 1.61719 12.6719 1.65625L11.8516 2.47656L7.82812 6.5Z\" fill=\"currentColor\"\/>\r\n\t\t\t\t\t\t\t<\/svg>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"first-name-adult-5\" class=\"block mb-2\">Voornaam*<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"first-name-adult-5\" id=\"first-name-adult-5\" placeholder=\"Vul uw voornaam in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"last-name-adult-5\" class=\"block mb-2\">Achternaam*<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"last-name-adult-5\" id=\"last-name-adult-5\" placeholder=\"Vul je achternaam in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"birth-date-adult-5\" class=\"block mb-2\">Geboortedatum*<\/label>\r\n\t\t\t\t\t<input type=\"date\" name=\"birth-date-adult-5\" id=\"birth-date-adult-5\" placeholder=\"Voer je geboorte datum in\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"gender-adult-5\" class=\"block mb-2\">Geslacht*<\/label>\r\n\t\t\t\t\t<select type=\"date\" name=\"gender-adult-5\" id=\"gender-adult-5\" placeholder=\"Gender\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t\t\t<option value=\"\">Selecteer<\/option>\t\r\n\t\t\t\t\t\t<option value=\"Man\">Man<\/option>\r\n\t\t\t\t\t\t<option value=\"Vrouw\">Vrouw<\/option>\r\n\t\t\t\t\t\t<option value=\"Ander\">Ander<\/option>\r\n\t\t\t\t\t<\/select>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"phone-adult-5\" class=\"block mb-2\">Tel. mobiel*<\/label>\r\n\t\t\t\t\t<input type=\"tel\" name=\"phone-adult-5\" id=\"phone-adult-5\" placeholder=\"Enter your phone number\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"email-adult-5\" class=\"block mb-2\">E-mailadres*<\/label>\r\n\t\t\t\t\t<input type=\"email\" name=\"email-adult-5\" id=\"email-adult-5\" placeholder=\"Enter your email\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\t\t<\/section>\r\n\t<\/div>\r\n\r\n\t<div>\r\n\t\t<div class=\"buttonAddAdult bg-primary-lighter rounded-full text-lg w-full mt-[10px] py-4 px-7 flex uppercase justify-center items-center cursor-pointer font-title hover:bg-primary hover:text-white transition duration-200 select-none disabled:opacity-80 disabled:hover:cursor-not-allowed\">Voeg een gezinslid toe (volwassene)<\/div>\r\n\t<\/div>\r\n\t<div>\r\n\t\t<div class=\"buttonAddChild bg-primary-lighter rounded-full text-lg w-full mt-[10px] py-4 px-7 flex uppercase justify-center items-center cursor-pointer font-title hover:bg-primary hover:text-white transition duration-200 select-none disabled:opacity-80 disabled:hover:cursor-not-allowed\">Voeg een gezinslid toe (kind)<\/div>\r\n\t<\/div>\r\n\t\r\n\r\n\t<div class=\"lg:col-span-2 text-center\">\r\n\t\t<hr class=\"mt-[10px] mb-[60px] h-px border-[#E5E5E5]\">\r\n\t\t<button type=\"submit\" 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