1.	Parent's full name*

Parent's address

First Line of address
Post code

Parent's contact telephone number(s)

Landline
Mobile

4.	Parent's email address

5.	Number of children who will be attending*

Age of each child:

		Age in years
Child one		2-11
Child two		2-11
Child three		2-11
Child four		2-11
Child five		2-11

Course title*

	4-week Family Kitchen early years programme (Zoom)
	4-week Family Kitchen primary programme (Zoom)
	Families for Life early years session (telephone)
	Families for Life primary session (telephone)

8.	Do you consider yourself or your child attending the programme to have a disability?
	Yes No

9.	If yes, please describe any special arrangements we need to make for you or your child to attend the programme.

10.	Do you have a computer and access to the internet to use Zoom? If no, and you would like to attend a zoom Family Kitchen programme, we might be able to set you up with equipment for the duration of the programme
	Yes No

11.	How did you hear about Families for Life / Family Kitchen?

Islington Council provides health and care services to adults, children and young people who are residents or in education in the London Borough of Islington.

We will handle the information you have provided in line with the provisions of the Data Protection Act 2018. Any personal information will be held in confidence with only the necessary people able to see or use it.

More information about how we use your information.

For more information about data protection and privacy, please contact the Senior Information Manager on 020 7527 2000, email
contact@islington.gov.uk or see the legal information on our website.