maqaad.sa Open in urlscan Pro
52.29.20.122  Public Scan

Form analysis
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<form id="forminator-module-25052" class="forminator-ui forminator-custom-form forminator-custom-form-25052 forminator-design--default  forminator_ajax" method="post" data-forminator-render="0" data-form-id="25052" data-design="default"
  data-grid="open" style="" data-uid="65647d9a71f6f" novalidate="novalidate">
  <div role="alert" aria-live="polite" class="forminator-response-message forminator-error" aria-hidden="true"></div>
  <div class="forminator-row">
    <div id="select-6" class="forminator-field-select forminator-col forminator-col-12 ">
      <div class="forminator-field"><label for="forminator-form-25052__field--select-6_65647d9a71f6f" id="forminator-form-25052__field--select-6_65647d9a71f6f-label" class="forminator-label">ادخل اسم المستشفى <span
            class="forminator-required">*</span></label><select id="forminator-form-25052__field--select-6_65647d9a71f6f" class="forminator-select--field forminator-select2 select2-hidden-accessible forminator-screen-reader-only" data-required="1"
          name="select-6" data-default-value="" data-placeholder="ادخل اسم المستشفى" data-search="false" aria-labelledby="forminator-form-25052__field--select-6_65647d9a71f6f-label"
          aria-describedby="forminator-form-25052__field--select-6_65647d9a71f6f-description" data-select2-id="select2-data-forminator-form-25052__field--select-6_65647d9a71f6f" tabindex="-1" aria-hidden="true">
          <option value="" data-select2-id="select2-data-2-t6ho">ادخل اسم المستشفى</option>
          <option value="أنثى" data-calculation="0">مستشفى الولادة والاطفال - تبوك</option>
          <option value="ذكر" data-calculation="0">مستشفى الملك خالد - تبوك</option>
          <option value="مستشفى-الامير-فهد-بن-سلطان---تبوك" data-calculation="0">مستشفى الامير فهد بن سلطان - تبوك</option>
          <option value="مستشفى-الملك-سلمان-للقوات-المسلحة-بالشمالية-الغربية" data-calculation="0">مستشفى الملك سلمان للقوات المسلحة بالشمالية الغربية</option>
          <option value="مستشفى-املج-العام" data-calculation="0">مستشفى املج العام</option>
          <option value="مستشفى-البدع-العام" data-calculation="0">مستشفى البدع العام</option>
          <option value="مستشفى-تيماء-العام" data-calculation="0">مستشفى تيماء العام</option>
          <option value="مستشفى-ضباء-العام" data-calculation="0">مستشفى ضباء العام</option>
          <option value="مستشفى-حقل-العام" data-calculation="0">مستشفى حقل العام</option>
          <option value="مستشفى-الوجه-العام" data-calculation="0">مستشفى الوجه العام</option>
          <option value="مستشفى-اشواق-العام" data-calculation="0">مستشفى اشواق العام</option>
          <option value="مستشفى-ابوراكة-العام" data-calculation="0">مستشفى ابوراكة العام</option>
          <option value="مستشفى-نيوم" data-calculation="0">مستشفى نيوم</option>
          <option value="اخرى" data-calculation="0">اخرى</option>
        </select><span class="select2 select2-container forminator-select" dir="ltr" data-select2-id="select2-data-1-9ljc" style="width: 270px;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
              aria-haspopup="true" aria-expanded="false" tabindex="0" aria-disabled="false" aria-describedby="forminator-form-25052__field--select-6_65647d9a71f6f-description"
              aria-labelledby="select2-forminator-form-25052__field--select-6_65647d9a71f6f-container" aria-controls="select2-forminator-form-25052__field--select-6_65647d9a71f6f-container"><span class="select2-selection__rendered"
                id="select2-forminator-form-25052__field--select-6_65647d9a71f6f-container" role="textbox" aria-readonly="true" title="ادخل اسم المستشفى"><span class="select2-selection__placeholder">ادخل اسم المستشفى</span></span><span
                class="select2-selection__arrow" role="presentation"><span class="forminator-icon-chevron-down" aria-hidden="true"></span></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span></div>
    </div>
  </div>
  <div class="forminator-row">
    <div id="name-1" class="forminator-field-name forminator-col forminator-col-6 ">
      <div class="forminator-field"><label for="forminator-field-name-1_65647d9a71f6f" class="forminator-label" id="forminator-field-name-1_65647d9a71f6f-label">أدخل الاسم الثلاثي <span class="forminator-required">*</span></label><input type="text"
          name="name-1" value="" placeholder="أدخل الاسم الثلاثي" id="forminator-field-name-1_65647d9a71f6f" class="forminator-input forminator-name--field" aria-required="true"></div>
    </div>
    <div id="text-3" class="forminator-field-text forminator-col forminator-col-6 ">
      <div class="forminator-field"><label for="forminator-field-text-3_65647d9a71f6f" class="forminator-label" id="forminator-field-text-3_65647d9a71f6f-label">أدخل الجنسية <span class="forminator-required">*</span></label><input type="text"
          name="text-3" value="" placeholder="سعودي/ة" id="forminator-field-text-3_65647d9a71f6f" class="forminator-input forminator-name--field" data-required="1"></div>
    </div>
  </div>
  <div class="forminator-row">
    <div id="select-1" class="forminator-field-select forminator-col forminator-col-6 ">
      <div class="forminator-field"><label for="forminator-form-25052__field--select-1_65647d9a71f6f" id="forminator-form-25052__field--select-1_65647d9a71f6f-label" class="forminator-label">صلة قرابتك للمولود <span
            class="forminator-required">*</span></label><select id="forminator-form-25052__field--select-1_65647d9a71f6f" class="forminator-select--field forminator-select2 select2-hidden-accessible forminator-screen-reader-only" data-required="1"
          name="select-1" data-default-value="" data-placeholder="صلة قرابتك للمولود" data-search="false" aria-labelledby="forminator-form-25052__field--select-1_65647d9a71f6f-label"
          aria-describedby="forminator-form-25052__field--select-1_65647d9a71f6f-description" data-select2-id="select2-data-forminator-form-25052__field--select-1_65647d9a71f6f" tabindex="-1" aria-hidden="true">
          <option value="" data-select2-id="select2-data-4-6umu">صلة قرابتك للمولود</option>
          <option value="الأم" data-calculation="0">الأم</option>
          <option value="الأب" data-calculation="0">الأب</option>
          <option value="الأخ" data-calculation="0">الأخ</option>
          <option value="الأخت" data-calculation="0">الأخت</option>
          <option value="أخرى" data-calculation="0">أخرى</option>
        </select><span class="select2 select2-container forminator-select" dir="ltr" data-select2-id="select2-data-3-wdwd" style="width: 133px;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
              aria-haspopup="true" aria-expanded="false" tabindex="0" aria-disabled="false" aria-describedby="forminator-form-25052__field--select-1_65647d9a71f6f-description"
              aria-labelledby="select2-forminator-form-25052__field--select-1_65647d9a71f6f-container" aria-controls="select2-forminator-form-25052__field--select-1_65647d9a71f6f-container"><span class="select2-selection__rendered"
                id="select2-forminator-form-25052__field--select-1_65647d9a71f6f-container" role="textbox" aria-readonly="true" title="صلة قرابتك للمولود"><span class="select2-selection__placeholder">صلة قرابتك للمولود</span></span><span
                class="select2-selection__arrow" role="presentation"><span class="forminator-icon-chevron-down" aria-hidden="true"></span></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span></div>
    </div>
    <div id="text-4" class="forminator-field-text forminator-col forminator-col-6 ">
      <div class="forminator-field"><label for="forminator-field-text-4_65647d9a71f6f" class="forminator-label" id="forminator-field-text-4_65647d9a71f6f-label">السجل المدني لوالدة الطفل <span class="forminator-required">*</span></label><input
          type="text" name="text-4" value="" placeholder="11********" id="forminator-field-text-4_65647d9a71f6f" class="forminator-input forminator-name--field" data-required="1" maxlength="10"><span
          id="forminator-field-text-4_65647d9a71f6f-description" class="forminator-description"><span data-limit="10" data-type="characters">0 / 10</span></span></div>
    </div>
  </div>
  <div class="forminator-row">
    <div id="name-2" class="forminator-field-name forminator-col forminator-col-6 ">
      <div class="forminator-field"><label for="forminator-field-name-2_65647d9a71f6f" class="forminator-label" id="forminator-field-name-2_65647d9a71f6f-label">اسم المولود <span class="forminator-required">*</span></label><input type="text"
          name="name-2" value="" placeholder="اسم المولود" id="forminator-field-name-2_65647d9a71f6f" class="forminator-input forminator-name--field" aria-required="true"></div>
    </div>
    <div id="name-3" class="forminator-field-name forminator-col forminator-col-6 ">
      <div class="forminator-field"><label for="forminator-field-name-3_65647d9a71f6f" class="forminator-label" id="forminator-field-name-3_65647d9a71f6f-label">اسم والدة الطفل <span class="forminator-required">*</span></label><input type="text"
          name="name-3" value="" placeholder="اسم والدة الطفل" id="forminator-field-name-3_65647d9a71f6f" class="forminator-input forminator-name--field" aria-required="true"></div>
    </div>
  </div>
  <div class="forminator-row">
    <div id="select-2" class="forminator-field-select forminator-col forminator-col-6 ">
      <div class="forminator-field"><label for="forminator-form-25052__field--select-2_65647d9a71f6f" id="forminator-form-25052__field--select-2_65647d9a71f6f-label" class="forminator-label">جنس المولود <span
            class="forminator-required">*</span></label><select id="forminator-form-25052__field--select-2_65647d9a71f6f" class="forminator-select--field forminator-select2 select2-hidden-accessible forminator-screen-reader-only" data-required="1"
          name="select-2" data-default-value="" data-placeholder="جنس المولود" data-search="false" aria-labelledby="forminator-form-25052__field--select-2_65647d9a71f6f-label"
          aria-describedby="forminator-form-25052__field--select-2_65647d9a71f6f-description" data-select2-id="select2-data-forminator-form-25052__field--select-2_65647d9a71f6f" tabindex="-1" aria-hidden="true">
          <option value="" data-select2-id="select2-data-6-ru2q">جنس المولود</option>
          <option value="أنثى" data-calculation="0">أنثى</option>
          <option value="ذكر" data-calculation="0">ذكر</option>
        </select><span class="select2 select2-container forminator-select" dir="ltr" data-select2-id="select2-data-5-4afc" style="width: 105px;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
              aria-haspopup="true" aria-expanded="false" tabindex="0" aria-disabled="false" aria-describedby="forminator-form-25052__field--select-2_65647d9a71f6f-description"
              aria-labelledby="select2-forminator-form-25052__field--select-2_65647d9a71f6f-container" aria-controls="select2-forminator-form-25052__field--select-2_65647d9a71f6f-container"><span class="select2-selection__rendered"
                id="select2-forminator-form-25052__field--select-2_65647d9a71f6f-container" role="textbox" aria-readonly="true" title="جنس المولود"><span class="select2-selection__placeholder">جنس المولود</span></span><span
                class="select2-selection__arrow" role="presentation"><span class="forminator-icon-chevron-down" aria-hidden="true"></span></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span></div>
    </div>
    <div id="date-1" class="forminator-field-date forminator-col forminator-col-6 ">
      <div class="forminator-field"><label for="forminator-field-date-1-picker_65647d9a71f6f" class="forminator-label" id="forminator-field-date-1-picker_65647d9a71f6f-label">تاريخ ميلاده <span class="forminator-required">*</span></label>
        <div class="forminator-input-with-icon"><label for="forminator-field-date-1-picker_65647d9a71f6f"><span class="forminator-icon-calendar" aria-hidden="true"></span></label><input autocomplete="off" type="text" size="1" name="date-1" value=""
            placeholder="تاريخ ميلاده" id="forminator-field-date-1-picker_65647d9a71f6f" class="forminator-input forminator-datepicker hasDatepicker" data-required="1" data-format="dd-mm-yy" data-restrict-type="" data-restrict=""
            data-start-year="1923" data-end-year="2123" data-past-dates="enable" data-start-of-week="0" data-start-date="" data-end-date="" data-start-field="" data-end-field="" data-start-offset="" data-end-offset="" data-disable-date=""
            data-disable-range=""></div>
      </div>
    </div>
  </div>
  <div class="forminator-row">
    <div id="phone-1" class="forminator-field-phone forminator-col forminator-col-12 ">
      <div class="forminator-field"><label for="forminator-field-phone-1_65647d9a71f6f" class="forminator-label" id="forminator-field-phone-1_65647d9a71f6f-label">رقم الجوال <span class="forminator-required">*</span></label><input type="text"
          name="phone-1" value="" placeholder="0500000000" id="forminator-field-phone-1_65647d9a71f6f" class="forminator-input forminator-field--phone" data-required="1" aria-required="true" autocomplete="off"></div>
    </div>
  </div>
  <div class="forminator-row">
    <div id="email-1" class="forminator-field-email forminator-col forminator-col-12 ">
      <div class="forminator-field"><label for="forminator-field-email-1_65647d9a71f6f" class="forminator-label" id="forminator-field-email-1_65647d9a71f6f-label">البريد الإلكتروني <span class="forminator-required">*</span></label><input type="email"
          name="email-1" value="" placeholder="البريد الإلكتروني" id="forminator-field-email-1_65647d9a71f6f" class="forminator-input forminator-email--field" data-required="1" aria-required="true"></div>
    </div>
  </div>
  <div class="forminator-row">
    <div id="address-1" class="forminator-field-address forminator-col forminator-col-12 ">
      <div class="forminator-row">
        <div id="address-1-street_address" class="forminator-col">
          <div class="forminator-field"><label for="forminator-field-address-1-street_address_65647d9a71f6f" class="forminator-label" id="forminator-field-address-1-street_address_65647d9a71f6f-label">عنوان المنزل (المدينة والحي) <span
                class="forminator-required">*</span></label><input type="text" name="address-1-street_address" placeholder="عنوان المنزل" id="forminator-field-address-1-street_address_65647d9a71f6f" class="forminator-input" data-required="1"
              aria-required="true" value=""></div>
        </div>
      </div>
    </div>
  </div>
  <div class="forminator-row">
    <div id="select-5" class="forminator-field-select forminator-col forminator-col-12 ">
      <div class="forminator-field"><label for="forminator-form-25052__field--select-5_65647d9a71f6f" id="forminator-form-25052__field--select-5_65647d9a71f6f-label" class="forminator-label">المنطقة <span
            class="forminator-required">*</span></label><select id="forminator-form-25052__field--select-5_65647d9a71f6f" class="forminator-select--field forminator-select2 select2-hidden-accessible forminator-screen-reader-only" data-required="1"
          name="select-5" data-default-value="" data-placeholder="المنطقة" data-search="false" aria-labelledby="forminator-form-25052__field--select-5_65647d9a71f6f-label"
          aria-describedby="forminator-form-25052__field--select-5_65647d9a71f6f-description" data-select2-id="select2-data-forminator-form-25052__field--select-5_65647d9a71f6f" tabindex="-1" aria-hidden="true">
          <option value="" data-select2-id="select2-data-8-cwr0">المنطقة</option>
          <option value="منطقة-تبوك" data-calculation="0">منطقة تبوك</option>
          <option value="اخرى" data-calculation="0">اخرى</option>
        </select><span class="select2 select2-container forminator-select" dir="ltr" data-select2-id="select2-data-7-9com" style="width: 99px;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
              aria-haspopup="true" aria-expanded="false" tabindex="0" aria-disabled="false" aria-describedby="forminator-form-25052__field--select-5_65647d9a71f6f-description"
              aria-labelledby="select2-forminator-form-25052__field--select-5_65647d9a71f6f-container" aria-controls="select2-forminator-form-25052__field--select-5_65647d9a71f6f-container"><span class="select2-selection__rendered"
                id="select2-forminator-form-25052__field--select-5_65647d9a71f6f-container" role="textbox" aria-readonly="true" title="المنطقة"><span class="select2-selection__placeholder">المنطقة</span></span><span class="select2-selection__arrow"
                role="presentation"><span class="forminator-icon-chevron-down" aria-hidden="true"></span></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span></div>
    </div>
  </div>
  <div class="forminator-row">
    <div id="select-4" class="forminator-field-select forminator-col forminator-col-12 ">
      <div class="forminator-field"><label for="forminator-form-25052__field--select-4_65647d9a71f6f" id="forminator-form-25052__field--select-4_65647d9a71f6f-label" class="forminator-label">هل سبق لك استخدام مَقعد الطفل؟ <span
            class="forminator-required">*</span></label><select id="forminator-form-25052__field--select-4_65647d9a71f6f" class="forminator-select--field forminator-select2 select2-hidden-accessible forminator-screen-reader-only" data-required="1"
          name="select-4" data-default-value="" data-placeholder="هل سبق لك استخدام مَقعد الطفل؟" data-search="false" aria-labelledby="forminator-form-25052__field--select-4_65647d9a71f6f-label"
          aria-describedby="forminator-form-25052__field--select-4_65647d9a71f6f-description" data-select2-id="select2-data-forminator-form-25052__field--select-4_65647d9a71f6f" tabindex="-1" aria-hidden="true">
          <option value="" data-select2-id="select2-data-10-51rc">هل سبق لك استخدام مَقعد الطفل؟</option>
          <option value="نعم" data-calculation="0">نعم</option>
          <option value="لا" data-calculation="0">لا</option>
        </select><span class="select2 select2-container forminator-select" dir="ltr" data-select2-id="select2-data-9-5n6x" style="width: 185px;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
              aria-haspopup="true" aria-expanded="false" tabindex="0" aria-disabled="false" aria-describedby="forminator-form-25052__field--select-4_65647d9a71f6f-description"
              aria-labelledby="select2-forminator-form-25052__field--select-4_65647d9a71f6f-container" aria-controls="select2-forminator-form-25052__field--select-4_65647d9a71f6f-container"><span class="select2-selection__rendered"
                id="select2-forminator-form-25052__field--select-4_65647d9a71f6f-container" role="textbox" aria-readonly="true" title="هل سبق لك استخدام مَقعد الطفل؟"><span class="select2-selection__placeholder">هل سبق لك استخدام مَقعد
                  الطفل؟</span></span><span class="select2-selection__arrow" role="presentation"><span class="forminator-icon-chevron-down" aria-hidden="true"></span></span></span></span><span class="dropdown-wrapper"
            aria-hidden="true"></span></span></div>
    </div>
  </div>
  <div class="forminator-row">
    <div id="select-3" class="forminator-field-select forminator-col forminator-col-12 ">
      <div class="forminator-field"><label for="forminator-form-25052__field--select-3_65647d9a71f6f" id="forminator-form-25052__field--select-3_65647d9a71f6f-label" class="forminator-label">هل هذا مولودك الأول؟ <span
            class="forminator-required">*</span></label><select id="forminator-form-25052__field--select-3_65647d9a71f6f" class="forminator-select--field forminator-select2 select2-hidden-accessible forminator-screen-reader-only" data-required="1"
          name="select-3" data-default-value="" data-placeholder="هل هذا مولودك الأول؟" data-search="false" aria-labelledby="forminator-form-25052__field--select-3_65647d9a71f6f-label"
          aria-describedby="forminator-form-25052__field--select-3_65647d9a71f6f-description" data-select2-id="select2-data-forminator-form-25052__field--select-3_65647d9a71f6f" tabindex="-1" aria-hidden="true">
          <option value="" data-select2-id="select2-data-12-wziq">هل هذا مولودك الأول؟</option>
          <option value="نعم" data-calculation="0">نعم</option>
          <option value="لا" data-calculation="0">لا</option>
        </select><span class="select2 select2-container forminator-select" dir="ltr" data-select2-id="select2-data-11-eegf" style="width: 145px;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
              aria-haspopup="true" aria-expanded="false" tabindex="0" aria-disabled="false" aria-describedby="forminator-form-25052__field--select-3_65647d9a71f6f-description"
              aria-labelledby="select2-forminator-form-25052__field--select-3_65647d9a71f6f-container" aria-controls="select2-forminator-form-25052__field--select-3_65647d9a71f6f-container"><span class="select2-selection__rendered"
                id="select2-forminator-form-25052__field--select-3_65647d9a71f6f-container" role="textbox" aria-readonly="true" title="هل هذا مولودك الأول؟"><span class="select2-selection__placeholder">هل هذا مولودك الأول؟</span></span><span
                class="select2-selection__arrow" role="presentation"><span class="forminator-icon-chevron-down" aria-hidden="true"></span></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span></div>
    </div>
  </div>
  <div class="forminator-row">
    <div id="checkbox-1" class="forminator-field-checkbox forminator-col forminator-col-12 ">
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 * عن المبادرة
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 * عن المبادرة
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.منصة التقديم على مَقعد -نيوم

Homepage•.منصة التقديم على مَقعد -نيوم

امتدادًا لجهود المسؤولية الاجتماعية في نيوم، وحرصها على سلامة وصحة أهالي
المنطقة، نسعى بعون الله إلى مساعدة أولياء الأمور في تعزيز إجراءات السلامة التي
تمنحهم الطمأنينة وراحة البال حول سلامة أطفالهم

الشروط والأحكام

المقاعد مقدمة للمواليد بدايةً من 1 أكتوبر 2022 في منطقة تبوك ونيوم

 

For English
ادخل اسم المستشفى *ادخل اسم المستشفىمستشفى الولادة والاطفال - تبوكمستشفى الملك
خالد - تبوكمستشفى الامير فهد بن سلطان - تبوكمستشفى الملك سلمان للقوات المسلحة
بالشمالية الغربيةمستشفى املج العاممستشفى البدع العاممستشفى تيماء العاممستشفى
ضباء العاممستشفى حقل العاممستشفى الوجه العاممستشفى اشواق العاممستشفى ابوراكة
العاممستشفى نيوماخرىادخل اسم المستشفى
أدخل الاسم الثلاثي *
أدخل الجنسية *
صلة قرابتك للمولود *صلة قرابتك للمولودالأمالأبالأخالأختأخرىصلة قرابتك للمولود
السجل المدني لوالدة الطفل *0 / 10
اسم المولود *
اسم والدة الطفل *
جنس المولود *جنس المولودأنثىذكرجنس المولود
تاريخ ميلاده *

رقم الجوال *
البريد الإلكتروني *
عنوان المنزل (المدينة والحي) *
المنطقة *المنطقةمنطقة تبوكاخرىالمنطقة
هل سبق لك استخدام مَقعد الطفل؟ *هل سبق لك استخدام مَقعد الطفل؟نعملاهل سبق لك
استخدام مَقعد الطفل؟
هل هذا مولودك الأول؟ *هل هذا مولودك الأول؟نعملاهل هذا مولودك الأول؟

أوافق على الشروط والأحكام وأرغب باستلام مقعد طفل مجاني وأتعهد بالالتزام بتثبيت
الطفل في المَقعد بالطريقة الصحيحة والتجاوب مع فريق مؤسسة مَقعد *

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