V61 Jigsaw 
Hello Parents and Carers

Jigsaw is a children's club for years 3-6 (7-11 years old) which runs on Fridays during term time (6:00pm to 7:00pm) at Vineyard61 West side Church (Melody Road, Wandsworth, London, SW18 2QQ). All young people from any background or faith are welcome. 

We would like to ensure the safety of the children that are in our care. Please fill out all the information below so that we can better serve our kids. ONE FORM PER CHILD

This is a safeguarding requirement for every child and young person that is under our care. Data privacy is important to us, and we want to communicate with the children who attend our activities in a way which has appropriate consent, and which is in line with UK law on data protection. 

If you have any questions you may email me at jennifer@vineyard61.org 
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Email *
Name: *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
What school does your child attend? *
What School year are they in? *
What church do you attend? (if not applicable = N/a)
If you attend V61 please indicate what site. 
 *
Parent/ Carer name *
Parent/Carer email and phone number *
Permissions for contact with Parent/Carer *
Required
Photo/video consent *
Required
Medical needs or concerns or anything we need to be aware of?
(Allergies, ADHD, Autism, etc)
TWO emergency contacts 
Please include Name, connection to the child and their phone numbers
 *
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