Rozporządzenie Ministra Pracy i Polityki Społecznej z dnia 22 grudnia 2011 r. w sprawie wzoru kwestionariusza wywiadu adopcyjnego oraz wzoru karty dzi

Dziennik Ustaw Nr 292 Elektronicznie podpisany przez Grzegorz Paczowski Data: 2011.12.30 22:33:12 +01'00' — 17055 — Poz. 1721 1721 v.p l ROZPORZĄDZENIE MINISTRA PRACY I POLITYKI SPOŁECZNEJ1) z dnia 22 grudnia 2011 r. w sprawie wzoru kwestionariusza wywiadu adopcyjnego oraz wzoru karty dziecka Na podstawie art. 175 ustawy z dnia 9 czerwca 2011 r. o wspieraniu rodziny i systemie pieczy zastępczej (Dz. U. Nr 149, poz. 887 i Nr 288, poz. 1690) zarządza się, co następuje: 1) Minister Pracy i Polityki Społecznej kieruje działem admi- 1) kwestionariusza wywiadu adopcyjnego, stanowiący załącznik nr 1 do rozporządzenia; 2) karty dziecka, stanowiący załącznik nr 2 do rozporządzenia. §

1. Rozporządzenie wchodzi w życie z dniem 1 stycznia 2012 r. Minister Pracy i Polityki Społecznej: W. Kosiniak-Kamysz ww w. rcl .go nistracji rządowej — rodzina, na podstawie § 1 ust. 2 pkt 3 rozporządzenia Prezesa Rady Ministrów z dnia 18 listopada 2011 r. w sprawie szczegółowego zakresu działania Ministra Pracy i Polityki Społecznej (Dz. U. Nr 248, poz. 1485). §
2. Określa się wzór: Dziennik Ustaw Nr 292 — 17056 — Poz. 1721 v.p l Załączniki do rozporządzenia Ministra Pracy i Polityki Społecznej z dnia 22 grudnia 2011 r. (poz. 1721) Załącznik nr 1 WZÓR ………………………………….. (PieczĊü oĞURGNDDGRSF\MQHJR  KWESTIONARIUSZ WYWIADU ADOPCYJNEGO
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IV. Inne informacje, które kandydaci chcieliby podaü .......................................................................................................................................................... .......................................................................................................................................................... .......................................................................................................................................................... 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'DWDLSRGSLVRVRE\SU]HSURZDG]DMąFHMZ\ZLDG  Dziennik Ustaw Nr 292 — 17059 — Poz. 1721 WZÓR v.p l Załącznik nr 2 KARTA DZIECKA* oĞURGHNDGRSF\MQ\RGSRZLHG]LDOQ\]DNZDOLILNDFMĊG]LHFNDGRSU]\VSRVRELHQLD  ......................................................................................................................................................... . I. DANE OSOBOWE DZIECKA .go ImiĊ (imiona) .................................................................................................................................. Nazwisko ......................................................................................................................................... 'DWDLPLHMVFHXURG]HQLD....................................................................................... $GUHVPLHMVFD]DPLHV]NDQLD................................................................................... II. DANE O RODZICACH BIOLOGICZNYCH DZIECKA
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Dziennik Ustaw Nr 292 — 17060 — Poz. 1721 v.p l .......................................................................................................................................................... .......................................................................................................................................................... .......................................................................................................................................................... III. SYTUACJA PRAWNA DZIECKA**  5RG]LFH]RVWDOLSR]EDZLHQLZãDG]\URG]LFLHOVNLHM orzeczeniem sądu w ........................................................................................................................ 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IV. RODZEēSTWO DZIECKA
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11. Aktualny stan zdrowia dziecka waga.............................................................................................................................................. wzrost............................................................................................................................................ REZyGJãRZ\......................................................................................... wzrok............................................................................................................................................. VãXFK................................................................................................ %DGDQLDQHXURORJLF]QHLLQQHVSHFMDOLVW\F]QH ....................................................................................................................................................... ....................................................................................................................................................... ....................................................................................................................................................... ....................................................................................................................................................... ....................................................................................................................................................... ....................................................................................................................................................... ww
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