Help Questionnaire

Child Information

Date of arrival in Israel

Child Data

Birthdate

Child Photos

Country of residence

Status

Hospital

Diagnosis

Document confirming the diagnosis

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Medicines

Through which company did you come for treatment

Additional Information

Religion

This information is provided to help us respect and honor your traditions and does not affect how we treat you in any way

Favorite toys, hobbies

Dream

Additional Requests

A Brief History of a Child

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Child's Family Information

Are there any siblings

Yes, there is No, one

Brother's or sister's name

Age

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Are they in Israel?

Yes, everyone is here Partly, not all No, the child itself

Additional Information

Contact Information

Residential Address

Name of child's father

Child's father's phone

Father's Passport Photos

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it could be .jpg .png

Name of child's mother

Child's Mother's Phone

Mother's Passport Photos

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it could be .jpg .png

Email of one of the parents

Do you give permission to post photos and information about the child on social networks and on the Foundation's website

Yes, I do No, I don't

Can we send you informational notices about our foundation and its activities?

Yes, send No, don't send

Yes, I agree to the processing of data