Al Thiqah Club for Disabled |

Type of Disability:

Full Name:

Date of Birth:

Nationality:

Job:

Social Status:

Phone:

Email:

Whatsapp Number:

ID Number:

Passport Number:

Building Area:

Emirate:

Home Address:

Apartment Number:

Number:

Father Name:

Father's Phone:

Father's Job:

Mother Name:

Mother Phone:

Mother Job:

Cause of Disability:

Date of Disability:

Chronic Disease:

Date of Last Medical Report:

Behavioural and emotional state:

Is he/she self reliant:

General Health Status:

Nationality:

Relative Relation:

Person Accompaying Member:

Phone:

Driver Phone:

Bus Number:

Bus Driver Name:

Cultural:

Athlete Phycial Therapy:

Activity Type Social:

Passport Copy:

Visa Copy:

Family book for citizens:

Recent medical report:

Personal Photo:

Disabled Card Photo:

Sheikhk Mohammed Bin Zayed Road,Emirates Road,Muwailih Commercial - Sharjah

info@tcd.shj.ae

+971- 6 538 9999

Al Thiqah Club