Application form

Contact person

Position

your e-mail

Your phone

Name of the hospital

City

Have any improvements been made to the ward in recent years?

What is the condition of the plumbing and electrical installations in the ward?

Does the unit have wireless internet?

How many rooms is the children's ward?

What kind of beds does the department have?

Does the ward have an intensive care unit?

How many children pass through the ward on an annual basis?

What is the condition of the premises in the department and what equipment and furniture do they have?

How many sanitary facilities does the department have?

What medical equipment does the children's ward need?

How do you envision the change in Firefly Rooms?

Do you have a space for a "Firefly Space" - a play and study area outside the hospital rooms?

What condition is it in? How do you envision the change?

Does the ward have a waiting room? If so, what condition is it in?

Is there ramp/elevator access to the unit?

Does the hospital have a yard or park?

What services do you provide to child patients and their companions outside of medical care? Please list.

What is the share of children and their accompanying persons with low social status? Do they need a "Firefly Wardrobe"? "Garderobche Svetulka" aims to provide essential items to those in need.

Do you have room for it? Where? Do you have staff to administer the locker so that it assesses the condition of the items and prevents them from being misused?

Please give a motivated description of why you want to apply for the Firefly Project.