CONTROL SOCIAL DE PADRES USUARIOS DEL PROGRAMA DE HOGARES COMUNITARIOS

DE BIENESTAR FAMILIAR.

ASOCIACION NUESTRO
FUTURO

HOGAR___________________________

MODALIDAD ATENDIDA___________________

MADRE COMUNITARIA____________________

NOMBRE DEL PADRE O MADRE: ______________________________________________________________________________________________________

FECHA DE LA VISITA: _____________________________________________________________________________________

HORA DE ENTRADA: ___________ HORA DE SALIDA___________

REGISTRO DE OBSERVACIONES DURANTE LA VISITA AL HOGAR:

________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________

RECOMENDACIONES:

________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
___________________________________________________
FIRMA DEL PADRE O MADRE FIRMA DEL AGENTE EDUCATIVO

____________________________ ______________________________