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雙老照顧支持團體 報名表單
時間:7/16、07/23、08/6、08/13、8/20、08/27 每週六 下午2:00-5:00
地點:高雄市家庭照顧者關懷協會(漢口街137號)
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樂齡相扶持,守護新人生
姓名
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Your answer
聯繫電話
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Your answer
電子信箱 (若無可跳過)
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照顧對象 (目前與照顧哪位家屬?)
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居住地區 (寫區即可)
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是否打過2劑疫苗達14天或活動前3天願意快篩(可複選)
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第一劑
第二劑
第三劑
快篩
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最後一次疫苗施打日期
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MM
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DD
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YYYY
備註(如:會提前10分鐘到)
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