JUMP18 Formulario pa inscribi/ JUMP18 Registration Form
Papiamento:
Masha danki pa bo interes den e programa JUMP18! Por fabor yena e formulario abou pa registra bo yiu pa e programa aki. Participation den e programa ta gratis y lo tuma luga den grupo di 18 mucha. Aki bou por schrijf in pa e wachtlijst pa medio 2022. Ora nos haya e fecha definitivo nos lo tuma contacto cu bo persona.

Criteria pa participa:
1. E mayornan y e mucha mester ta motiva pa cambia nan estilo di bida
2. E mucha mester ta classifica cu sobre peso of obesitas
3. E mucha mester tin AZV valido

JUMP18 ta un programa di seis luna cu ta enfoca riba e desaroyo di un estilo di bida sostenibel y saludabel pa muchanan (entre 4-18 aña) cu tin sobre peso of obesitas y nan mayornan/voogd.

E programa ta inclui:
1. Un consulta pa luna riba diasabra cu un pediatra, dietista y casemanager (Diasabra entre 8:30-1pm)
2. Un consulta telefonico cu un casemanager cada dos siman
3. Plan di alimentacion pa diferente grupo di edad
4. Lesnan di ehercicio den un grupo, 3 biaha pa siman (Dialuna, Diaranson y Diabierna entre 5:30-7:30)
5. Workshops den un grupo cada dos siman durante luna 2-6 di e programa (Diamars entre 6-7:30)


English:
Thank you for your interest in JUMP18! Please fill out the form below to register your child for this program. Participation is free and takes place in batches of 18 children per group. We will start with the first group of children on the 1st of November.

Participation criteria:
1. The parents and children need to be motivated to change their lifestyle
2. The child needs to be classified as overweight or obese
3. The child needs to have a valid AZV card

JUMP18 is a 6-month program aimed to help overweight/obese children (ages 4-18) and their parents/caregivers develop a sustainable healthy lifestyle.

The program includes:
1. One monthly consultation on Saturdays with a pediatrician, dietician, and case manager (Saturdays between 8:30-1pm)
2. Biweekly phone consultations with a casemanager
3. Meal plan for different age groups
4. Group workout sessions 3x per week (Monday, Wednesday and Friday between 5:30-7:30)
5. Biweekly group workshops throughout months 2-6 (Tuesday between 6-7:30)




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Nomber y fam di e mayor(nan) di e mucha/ Name and last name of the child’s parents *
Nomber y fam di e mucha/ Name and last name of the child *
Fecha di nacemento di e mucha/ Date of birth of the child *
MM
/
DD
/
YYYY
Haltura (den meter) di e mucha/ Child's height *
Cuanto e mucha ta pisa (den kilo)? / How much does the child weigh? *
Nomber di e huisarts di e mucha  *
E mucha ta of a wordo diagnostica cu un condicion cu lo por ta relevante pa tene na cuenta? Has the child been diagnosed with a condition  in the past that might be relevant for us to know?
Motivacion ta un criteria hopi importante den nos programa. Describi den algun palabra dicon abo como mayor y/of e mucha mes ta motiva pa forma parti di e programa JUMP18? / Motivation is a very important criteria to participate in our program. Describe why you and/or your child want to participate in JUMP18? *
Email adres/ Email address *
Number di telefon/ Phone number *
Bo persona tin preguntanan pa nos?/Do you have any questions for us?
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