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SOSTIENI SUBITO
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NEW SUBSCRIPTION

HAPPY TO ACCOMMODATE YOUR REQUEST

DOWNLOADABLE FORM
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    1.
    Country:
    2. Center:
    3.
    Who is filling the form?
    4.
    Email Address:
    • Information about the child •
    5. Name:
    6. Last name:
    7.
    Date of birth:
    8.
    Gender
    9.
    Class:
    10.
    Year of access to the center:
    11.
    Send us an updated photo of him/her!
    • Estado de saúde: • 12.
    Health condition:
    12.a
    Details on his/her health conditions:
    12.b
    Does he/she need medical attention?
    12.c
    What medicines does he/she need?
    13.
    The Child nutrition is:
    • Situação familiar: • 14.
    How many brothers/sisters does he/she have (EXCLUDING him/her)?
    15.
    Are the parents alive? [radio radio-genitorivivi use_label_element ‘all living’ “orphan of both” “motherless” ’fatherless’]
    15.a
    What did he/she/they die from?
    16.
    Where does the child live?
    [radio radio-onde use_label_element ‘At the hostel‘ “At parents” house’ ‘At relatives’ house’]
    16.a
    Why?
    17.
    Does the father (or legal guardian) work?
    17.a
    What job does the father (or legal guardian) do?
    17.b
    What is the wage in local currency per month? If not available, make an estimation
    18.
    [dipe_oneDoes the mother (or legal guardian) work? [/dipe_one]
    18.a
    What job does the mother (or legal guardian) do?
    18.b
    What is the wage in local currency per month? If not available, make an estimation.
    19.
    Is the family on welfare or receiving any kind of financial aid? Public or government aids.
    19.a
    What kind of financial aid does the family receive?
    20.
    Is there any parental relation or working relation between the family of the child and one of the center’s collaborators?
    Which?
    21.
    Description of the child and his/her family (history of the child and the family, family members, situation and conditions of the family and their home, character and description of the child and what he/she enjoys doing, academic performance, health condition of the child)
    22.
    Reasons for subscribing the child to the Project and date since the child has been attending activities in the center/hostel (please, write why you chose to subscribe the child to the Project and how long he/she has been attending activities there):
    23.
    What is his/her family situation?
    24.
    What does he like to do in his/her freetime? Please specify child behavior, personality, taste (food, sport), hobbies, any personal information?
    • House conditions • 25.
    Description of the family home (construction materials and conditions of the house):
    26.
    Does the family own the house or pay rent? [radio radio-casaalposnc use_label_element default:1 ‘it's their property’ ’they're renting it out’]
    27.
    Quantas pessoas moram na casa?
    28.
    How many rooms are in the house?
    29.
    Do they have electricity at home?
    38.
    Do they have running water at home?
    31.
    Do they have farm animals at home?
    32.
    Do they grow a vegetable garden at home?
    33.
    Does the family own at least one smartphone?
    34.
    Do they have appliances at home? (TV, refrigerator, washing machine, dish washer, PC, laptop, tablet)
    IN THE EVENT OF ANY CHANGES IN THE CHILD'S SCHOOL, FAMILY OR HEALTH SITUATION, IT IS MANDATORY TO IMMEDIATELY NOTIFY FAGGIO VALLOMBROSANO ASSOCIATION.

    Thank you!!!

    downloadable form
    back to the tools for centers