In order to receive assistance in the form of a food package, please fill out the form below. The form should contain personal data collected in accordance with the Law of Ukraine "On Personal Data Protection" No. 2297-VI dated June 01, 2010. To give your consent to the processing, use, dissemination and access to personal data, please check the appropriate box at the end of the form

*all fields are required!

Number of children under 14 years old
husband / wife