Health Checks for Wellness – Mary K Yap Foundation

hope for all orphans

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The Mary K Yap Foundation’s Health Assistance Program provides essential health and wellness checks through the #LifeLine2026 campaign initiative for orphaned children. By collaborating with physicians, nurses, and medical associations, we work to ensure that every child receives the care they need to maintain their health and well-being. Our collective efforts focus on fostering a compassionate healthcare network that supports these vulnerable children and helps them thrive daily.

FORM 08

Wellness Health Checks

Enhance Well-being

– Step 1 of 21) ORPHANAGE INFORMATION:LayoutHead Master:Children:Facebook / Website page:Email Address: *Years:Telephone No:(1) CONTACT INFORMATION *Address Line 1Address Line 2CityState / Province / RegionPostal CodeCountry2) TYPE OF ORPHANAGE (Check all that apply)

Others:Layout (copy)Volunteers on Site

No. of Volunteers:Paid Employees on Site

No. of EmployeesPower Generators on Site

Type and Wattage:3) ORPHANAGE LEADERSHIP ON SITE?

LayoutPriests:Monks:Nurses:Caretakers:Sisters:Teachers:Brothers:Student Mentors:4) COULD YOU SPECIFY EACH CHILD'S GRADE LEVEL AND CLASSIFICATION AS AN ORPHAN OR NON-ORPHAN?

LayoutCLASSIFICATION #1No. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenCLASSIFICATION #2No. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenCLASSIFICATION #3No. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenCLASSIFICATION #4No. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenCLASSIFICATION #5No. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenCLASSIFICATION #6No. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan ChildrenNo. of Orphan ChildrenNo. of Non-Orphan Children5) ENGLISH LANGUAGE SKILLS AMONG LEADERS:

LayoutLeader #1Leader #2Leader #3SpeakSpeakSpeakSpeakSpeakSpeakSpeakSpeakSpeakSpeakSpeakSpeakSpeakSpeakSpeakSpeakSpeakSpeakSpeakSpeakSpeakSpeakSpeakSpeakReadReadReadReadReadReadReadReadReadReadReadReadReadReadReadReadReadReadReadReadReadReadReadReadWriteWriteWriteWriteWriteWriteWriteWriteWriteWriteWriteWriteWriteWriteWriteWriteWriteWriteWriteWriteWriteWriteWriteWrite

The questions below should form the basis of a comprehensive health check services wellness plan for the orphanage, ensuring that the children’s physical, mental, and emotional needs are adequately addressed and monitored. Please include your responses on a separate piece of paper if required. A healthcare team member partner will develop and implement the plan to ensure its effectiveness and relevance.

The head orphanage/caretaker will initiate the form with the support of the Foundation’s Orphanage Ambassador representatives (If Required)

6) DO YOU HAVE A LIST OF CHILDREN’S NAMES, AGES, AND GENDERS TO PROVIDE?

LayoutChild ID No #1NameAgeGenderChild ID No #2NameAgeGenderChild ID No #3NameAgeGenderUpload File, attach a complete list.

Upload Excel Sheet

Click or drag a file to this area to upload.

7) DO ANY OF THE CHILDREN HAVE KNOWN MEDICAL CONDITIONS AND ALLERGIES?

Describe8) IS THE ORPHANAGE MAINTAINING COMPLETE AND UPDATED IMMUNIZATION RECORDS FOR ALL CHILDREN?

9) DO ANY CHILDREN REQUIRE CATCH-UP VACCINATIONS?

If yes, select some of the common vaccinations children need in consistent with the local Health requirements.

Hepatitis B (Birth
Second Choice
Third Choice

Birth to 6 YearsFill in8) IS THE ORPHANAGE PROVIDING BALANCED AND NUTRITIOUS MEALS THAT MEET THE DIETARY NEEDS OF ALL CHILDREN?

(a) Are there any dietary restrictions or specific nutritional needs for individual children?

Describe(b) Is there access to balanced and nutritious meals?

If No, please select from the list below the balanced and nutritious meals needed. (Check all that apply)9) DO THE CHILDREN REGULARLY RECEIVE MEDICAL CHECK-UPS AND NECESSARY HEALTHCARE SUPPORT AT THE ORPHANAGE?

(a) Do the children have regular access to healthcare professionals for check-ups?

(b) Are there any physical health concerns or complaints that need attention?

Describe10) ARE THE CHILDREN PROVIDED WITH MENTAL HEALTH SUPPORT AND COUNSELING SERVICES TO ENSURE THEIR EMOTIONAL WELL-BEING?

(a) Have any of the children exhibited signs of emotional or behavioral issues?

If Yes, please select signs of emotional or behavioral issues from the list below. (Check all that apply)(b) Is there access to mental health professionals or counseling services?

11) IS THE ORPHANAGE ENVIRONMENT MAINTAINED SAFELY WITH PROPER HYGIENE STANDARDS FOR ALL CHILDREN?

(a) Is the orphanage environment safe and free from hazards?

(b) Are there any recent injuries or accidents to report?

Describe(c) Are there proper hygiene facilities and practices in place?

If Yes, Select all that apply12) ARE ALL CHILDREN MEETING THEIR AGE-APPROPRIATE DEVELOPMENTAL MILESTONES AND GROWTH STANDARDS?

(b) Are there any concerns about developmental delays or disabilities?

Describe13) IS THE ORPHANAGE PROVIDING ADEQUATE EDUCATIONAL AND SOCIAL DEVELOPMENT OPPORTUNITIES FOR THE CHILDREN?

(a) Are the children attending school or receiving appropriate educational support?

If no, select that appropriate educational support that are need(b) Are there any social integration or adjustment issues?

If No, select that all apply for the provisioning of extracurricular activities14) DOES THE ORPHANAGE HAVE ADEQUATE RESOURCES AND PARTNERSHIPS TO SUPPORT CHILDREN’S HEALTH AND WELL-BEING?

(a) Are there partnerships with local healthcare providers and organizations?

(b) Select all that apply for orphanages or children's homes homes that are needed to support the health and well-being of the children.15) IS THERE A SYSTEM IN PLACE TO MONITOR AND COMMUNICATE CHILDREN’S HEALTH INFORMATION AND WELL-BEING UPDATES EFFECTIVELY?

(a) Are there any cultural or religious preferences or practices that should be respected?

(b) Do the children have proper identification and documentation?

(d) Are staff members trained in basic first aid and CPR?

(e) Are there plans for regular health check-ups and assessments?

(f) Is there a reporting system for any significant health issues or incidents?

(g) Do the children or staff have any specific health concerns or suggestions for improvement?

Describe(h) How will health information and updates be communicated to relevant stakeholders?(i) How will the health and well-being of the children be monitored over time?Do you have achievement certificates, reference letters, or photo collections from any charitable experiences to upload?

If yes, please upload here

Click or drag a file to this area to upload.

The information provided in the above Health Checks for Wellness form is true and accurate. We accept that the information will be used only for evaluation by the relevant selection and funding committees. Once our orphanage is ready to receive assistance, a separate terms and disclosure agreement will be needed before receiving charitable support and donations. This form will need to be updated yearly.

Acknowledgment by Submitter: (Reg. Form 08 Rev.5 2024)Address Line 1Address Line 2CityState / Province / RegionCountryDate Phone / Fax / Viber NumberEmail: / Signature: *WAIVER AGREEMENT & PRIVACY DATA COLLECTION POLICY *

Please click to read and accept in order to proceed.

Please send other useful information to signup@marykyapfoundation or fax to +1 415 901-0305. (Eg. organizational mission and objectives, photos, press-release if available)

The information provided in the above volunteer form is true and accurate. I accept the Terms and Conditions, WAIVER AGREEMENT and PRIVACY DATA COLLECTION POLICY.

I acknowledge that the relevant committees will only use the information for evaluation. I will provide any character reference upon request and after the initial assessment.
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