Place of Birth. Nationality: .................................................................................................... Passport number: ......................................................................................... Designated study track: …………………………………................................. agree on this contract under the following terms and conditions: General conditions:
Place of Birth. We support the concept of individualized care based on the unique circumstances and needs of the birthing woman and her family. The College of Midwives of Ontario requires midwives to be trained to attend home and hospital births and to provide clients with these options. Research has shown that, for healthy women enjoying a low risk pregnancy and receiving regular prenatal care, home birth is a safe and reasonable option. The choice of place of birth is a personal decision and many factors must be considered including: risk factors involving mother and/or baby, available facilities, distance from hospital and the environment in which the mother feels most secure. We believe that it is the parents' right to make an informed choice regarding birth setting, understanding that there are risks and benefits to both home and hospital births. Birth is a natural, normal process, but complications and emergencies can arise that require medical intervention. While the majority of complications can be detected prenatally, some may arise unexpectedly during labour and delivery or after the birth. Midwives carry resuscitation equipment, oxygen and medications to treat postpartum bleeding and are trained in emergency skills. Some complications can be handled safely and effectively in the home environment with a skilled midwife in attendance, while others may require transport to a hospital. The willingness to transfer to hospital when there are signs of complications is one of the things that makes home birth a safe option. LABOUR AND BIRTH We see our role as being part of a team, working together with the parents, family and friends (if present), to serve the birthing woman and her baby. Because giving birth is an extension of a woman's whole life, the ways in which a woman experiences labour and birth are many and varied. We are committed to respecting the individual values and needs of birthing families. Much of our work involves quiet observation, reassurance and labour support. Many women desire and achieve unmedicated childbirth. We will remain with you once active labour is established and the condition of mother and baby will be monitored and assessed. The second midwife will come when the birth is imminent. POST-PARTUM If there are no complications or interventions, a woman delivering in the hospital may go home two to three hours after birth. When a baby is born at home, we remain with the mother and baby until both are stable and secure. The minimum time we r...
Place of Birth. Education: Primary Middle School Secondary School College Other PERSONAL IDENTITY INFORMATION Type of ID National ID Residency ID Passport Family register Other: .................... ID No.: Place of Issue: Expiry Date ..../..../. H ..../..../. CE NATIONAL ADDRESS AND CONTACT INFORMATION Xxxxxxxx Xxxxxxx Xxxxxxx0: Xxxxxxxx Xx. Xxxxxx Name District Name of the City Post Code Additional Number Mobile phone3: Landline Number4:
Place of Birth. City County State
Place of Birth. With whom does the child live? If stepparent, please give name(s) FATHER’S NAME Name of Employer City Occupation Work Phone ext. Cell Phone Email MOTHER’S NAME Name of Employer City Occupation Work Phone ext. Cell Phone Email Church Membership of Parents _ Attend worship services regularly? Y N Child Baptized? Y N Date of Baptism: Month Year Where How did you learn about Little Palms School? BROTHERS/SISTERS DATE OF BIRTH ❖ Please Place an “X” For Desired Program and Payment Plan. ❖ Circle the days for the desired PS or PK Program PROGRAMS Preschool and Pre Kindergarten - August 3, 2021 – May 12, 2022 Annual Tuition Monthly Tuition Program PSAM 2-Day choose 2 days M T W T F 8:30 – 11:45 a.m. $ 1,500.00 $ 150.00 Program PSAM 3-Day choose 3 days M T W T F 8:30 – 11:45 a.m. $ 2,100.00 $ 210.00 Program PSAM 4-Day choose 4 days M T W T F 8:30 – 11:45 a.m. $ 2,500.00 $ 250.00 Program PSAM 5-Day Monday - Friday 8:30 – 11:45 a.m. $ 3,050.00 $ 305.00 Program PK 2-Day choose 2 days M T W T F 8:30 – 11:45 a.m. $ 1,500.00 $ 150.00 Program PK 3-Day choose 3 days M T W T F 8:30 – 11:45 a.m. $ 2,100.00 $ 210.00 Program PK 4-Day choose 4 days M T W T F 8:30 – 11:45 a.m. $ 2,500.00 $ 250.00 Program PK 5-Day Monday - Friday 8:30 – 11:45 a.m. $ 3,050.00 $ 305.00 Program ESAM Extended School Program A.M. 8:00 – 8:30 a.m. AM & PM - $ 6.00 per hour Program ESPM Extended School Program P.M. 11:45 a.m. – 3:45 p.m. (Billed on the ¼ hour) ❖ 5% discount for early enrollment – completed enrollment & fees received by May 1, 2021 ❖ ❖ 5% discount on second child tuition (lesser amount). ❖ 5% discount will be given if full payment of the annual tuition is made at registration. ❖ 10% discount on tuition for HOSANNA Lutheran Church members ❖ 25% discount to children of Military ❖ 50% discount to children of clergy (second child discount does not apply) ❖ Only one discount will be applied. The largest discount will be applied with the exception of multiple children.
Place of Birth. Place of birth Số (No.):.................................................................. Số (No.):......................................................................... CMND/Thẻ căn cước công dân/Hộ chiếu (*) ID card/ Civil identification card/ Passport Nơi cấp: ............................................................... Place of issue Ngày cấp: ………/………/……… Date of issue Ngày hết hạn:……/……/……… Nơi cấp: ...................................................................... Place of issue Ngày cấp: ………/………/……… Date of issue Ngày hết hạn:……/……/……… (Date of expire): (Date of expire): Mã số thuế (Tax code) …………………………………………………………... …………………………………………………………... Quốc tịch (*) Nationality Việt Nam (Vietnamese) Hoa kỳ (*) (America) Khác (Other) …………………………………. Việt Nam (Vietnamese) Hoa kỳ (*) (America) Khác (Other) ……………………………………….. Dân tộc (*) (Ethnic group) ……………………………………… ……………………………………… MB02D/RB-TKTT/2017 Trang 1/16 Đa quốc tịch (*) Multi-nationality Có Không Không quốc tịch Yes No No Nationality Có Không Không quốc tịch Yes No No Nationality Thị thực nhập cảnh (Trường hợp cá nhân người nước ngoài) Immigration visa (For the case of foreigner) Số (No.):.................................................................. Nơi cấp: ............................................................... Place of issue Ngày cấp: ………/………/……… Date of issue Ngày hết hạn: ………/………/………. Date of expire Số (No.):......................................................................... Nơi cấp: ...................................................................... Place of issue Ngày cấp: ………/………/……… Date of issue Ngày hết hạn: ………/………/………. Date of expire Tình trạng cư trú (*) Residence status Cư trú (Residence) Không cư trú (No residence) Thời gian còn cư trú tại Việt Nam (Remaining residence time in Vietnam) ……………………………………… Cư trú (Residence) Không cư trú (No residence) Thời gian còn cư trú tại Việt Nam (Remaining residence time in Vietnam) ……………………………………… Tình trạng hôn nhân(*) Marriage status Độc thân (Single) Kết hôn (Marriage) Ly hôn (Divorce) Khác(Other)…………………………………... Độc thân (Single) Kết hôn (Marriage) Ly hôn (Divorce) Khác(Other)…………………………………... Địa chỉ thường trú (*) Permanent residence ……………………………………… ……………………………………… ………………………………………… ……..…………………………………… Địa chỉ liên lạc (*) Contact ……………………………………… ……………………………………… ………………………………………… …………………………………………. Điện thoại liên lạc Telephone Di động (*) (Mobile):......................................... Nhà (...
Place of Birth. (City & State or Foreign Country) If applicable, Name and Address of participating lender or surety co.
Place of Birth. Date of Birth:......................................Marital Status:................................... Residential Address (Not P.O. Box):................................................................ ..................................................................................................................... ..................................................................................................................... Preferred mailing Address:.............................................................................
Place of Birth. NATIONALITY: ……………………………………… GENDER: MALE / FEMALE (circle one) IDENTITY PROOF: PASSPORT OR DRIVERS LICENCES #: ……………………………………………………. (Please attach a copy of the same) NEXT OF KIN: (NAME): ………………………………………………………………………………………………………. CONTACT #: …………………………………… RELATIONSHIP TO APLLICANT: ………………………………..
Place of Birth. Although one study found that among all races, foreign-born individuals have better retention in care than U.S. born counterparts (Hu et al., 2012), three studies suggest poorer retention in care among foreign-born individuals. Particularly, one study identified poor retention in care among foreign-born non-Hispanic Blacks and non-Hispanic Whites compared to U.S. born counterparts (Sheehan, Mauck, et al., 2017), with being born in the U.S. protective for retention in care (Xxxxx et al., 2018). Another study identified that Latinos born in Mexico and Central America, specifically Guatemala and Honduras, have poorer retention in care compared to Latinos born in the U.S. (Sheehan, Mauck, et al., 2017). Additionally, among Black, Caribbean-born immigrants from Bahamas, Trinidad, Tobago, and Haiti, retention in care is poorer compared to non-Hispanic White counterparts (Cyrus et al., 2017). Socioeconomic, Cultural, Environmental, and Political Conditions—Geographic Location. Within the U.S., disparities in retention in care also exist by geographic location. In regression models adjusting for demographic and HIV risk factors, the percentage of persons retained in care in the West and South lag behind those retained in the Northeast U.S. (Xxxxxxx et al., 2016). Racial differences by region are also evident with retention in care poorer among Black compared to White persons in the Southern U.S. (Xxxxxxx et al., 2016). Research in Tennessee suggests that within state disparities may also exist, as persons living with HIV in Nashville are less likely to be retained in care than those in Memphis (Xxxxxx et al., 2016). Evidence of disparities within a state’s cities or counties is limited. Determinants of Disparities in Retention in Care Physical and Mental Health. This review identified health conditions and HIV management as determinants of disparities in retention in care at the physical and mental health level of the adapted ecologic model. A lack of ongoing diagnostic and treatment services for comorbidities (Xxxxxxx-Xxxxxx et al., 2009), lack of funding assistance for comorbidity treatments (Xxxxxxx-Xxxxxx et al., 2009), and providers uninformed in managing HIV comorbidities (Xxxxxxxxxxxxxx et al., 2017) deter individuals not only from seeking medical assistance for health conditions, but also from routine HIV care. Additionally, feelings of frustration limit retention in care. Black women living with HIV reported feeling frustrated that they were always at the...
