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Student Volunteer
Primary member details
Name of Member
School Batch (Year)
Father's Name
Mother's Name
Place of residence
Parent's Address
Self Address
Your contact details
Phone
Email
Your Support for OurParents initiative
State / District / Village / Location for which the data is provided:
Kindly assist with the following information to build database of support for Our Parents.
You may list one or more contact for any of the below mentioned services:
Contacts for Medical services
Pharmacy for Allopathic medicines, Pharmacy for Ayurveda/ Homeopathy medicines, Diagnostic/Lab centers, Lab technician for home visits, Specialty Clinic Multi-specialty hospital, Specialist doctor, Ambulance service Caregiver service, Assisted care service, Dementia care service, Health Insurance agents
Contacts for Leisure Activities
Clubs, Yoga instructor, Physio / Fitness trainer , Tour Operator, Errand boy , Hospital Escort ,Doctor for Health talk, Eminent Politician , Literate Scholar , Special dignitary , Ex-servicemen , Others
Contacts for Home Services
Gardener, Electrician , Plumber , Carpenter, Mason , Painter , AC Mechanic , Electronics repair , Car Mechanic , IT technician , Food delivery , Supermarket for homedelivery
Contacts for Essential Service
EB , Water department, Advocate , Police , Fire Service , Cyber crime ,s Banking services , Pension office , Panchayat/Corporation , Senior Citizens help centre
Have your parents enrolled for the OurParents program ?
Yes
No
If ‘NO’ please share the reason:
Any other suggestions :
Would you wish to volunteer as member of the support group for OurParents ?
Yes
No
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