Adult raised by a birth parent and searching for other parent/family (SC)

Contact Adoption Jigsaw

2A Curtin Avenue, Cottesloe 6011

Post Box 819
Cottesloe 6911

Phone: 08 9384 0222
Fax: 08 9384 7192
Email address:
jigsaw@jigsaw.org.au
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Adult raised by a birth parent and searching for other parent/family (SC) – A3 Membership Form

JIGSAW FEES – $280 incl. GST

Jigsaw is a membership based not-for-profit organisation. To reduce administration costs we charge one fee regardless of the search and mediation work involved.

Membership entitles you to:

Full Voting Rights
Newsletter – Jigsaw Pieces published bi-monthly.
Use of Jigsaw library
Registration on our Contact Register
Use of Jigsaw facilities for search

Please contact us to discuss any special problems with fees.

It is not possible to advise you regularly about the progress of your search or mediation, however you are welcome to contact us for an up date.

Create Downloadable Membership Application

Please enter details into the following form fields. Once complete click the Submit button to download a PDF version of the membership form.

Print this form and then fill in the outstanding details such as payment details and signatures.

Once complete please send the signed, completed form to Jigsaw by either email, fax or post.

Your Details

Title
Gender
Date of Birth
Surname
First Name
Second Name
Address
Postcode
State
Country
Can we write to this address?
Phone (H)
Phone (W)
Mobile
Email
Can we leave a message at these phone numbers?
Perth Clients Only - Can we send you a text or email reminder of Jigsaw event/support meetings?
Any special instructions in regards to contacting you?
Have you had any contact with any member of your birth family?
If Yes above, Who?
If Yes above, When?
For whom are you searching?
Relationship to you?

BIRTH MOTHER

(Information at the time of YOUR birth)

Surname
First Name
Second Name
Address
Current Name
Maiden Name
Date of Birth
Age when you were born?
Her place of birth
Marital Status at time of birth
Nationality
Occupation at time of birth
Any other signification information

BIRTH FATHER

(Information at the time of YOUR birth)

Surname
First Name
Second Name
Address
State
Post Code
Date of Birth
Age when you were born?
His place of birth
Nationality
Marital Status at time of your birth
Occupation
Have you had any contact with any member of your birth family?

Circumstances

Please give a brief description of your story

Your Documents

When sending through please attach copies of 2 identifying documents, eg driver's licence, passport, medicare card etc. Please attach photocopies (not the originals) of all relevant documentation , including your birth certificate.

Do you have a copy of your full birth certificate?

Searching

What enquiries/searching have you undertaken?

IMPORTANT INFO

Please provide details of a close contact NOT living at your address so that we can contact in the event you change your address and do not notify us:

Name
Address
Post Code
Phone (H)
Phone (W)
Mobile
Email
Relationship to you?
Can we identify ourselves as Jigsaw?

Contact Adoption Jigsaw

Make a Gold Coin Donation

Postcard Project

"Adoption Secrets"

Adoption Books

Join Adoption Jigsaw

Reconnections