BENEFICARY
Who is the beneficiary?
In our hippotherapy center, it includes beneficiary and beneficiary relatives who have special needs who want to benefit from the service within the scope of hippotherapy. To take advantage of the hippotherapy service, please fill out the form below completely.
*INFORMATION:
Within the framework of our work carried out within the scope of our project, the routine service delivery phase has not yet passed. The application forms you send to us are included in our "Potential Beneficiary" list. At appropriate stages, necessary evaluations will be made and you will definitely be contacted. Therefore, you do not need to follow up the appointment. Regards.
FOR THE BENEFICIARY RELATIVE:
PERSONAL INFORMATION
Name - Gender
First Name - Last Name
Gender
Place of Brith
Date of Brith
What Is Your Relativity With The Beneficiary?
1. Own
2. Parents
3. Relative (Specify)
4. Other (Specify)
Contact Information:
E-mail
example@example.com
Phone Number
Lütfen geçerli bir telefon numarası girin.
Adresses
Adress Line
Adres Satırı 2
İlçe
İl / Eyalet
Posta Kodu
Send
Should be Empty: