Student Information
First Name*

Last Name*

Preferred Name (If different from First Name)

Date of birth
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Gender
MaleFemale

Parent/Guardian 1
First Name*

Last Name*

Relationship to student

Email address*
Phone number

Address
House name/number*
Street*
City/Town*
Postcode*
Country*

Parent/Guardian 2
First Name

Last Name

Relationship to student

Email address
Phone number

Address
House name/number
Street
City/Town
Postcode
Country

Previous Schooling
Has your child attended school or day-care before?
YesNo
If yes, what school or day-care?

Dates attended: From
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Dates attended: To
Day12345678910111213141516171819202122232425262728293031MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberYear2020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990

Teacher Contact
Name of most recent teacher

Teacher email address
Teacher phone number
Permission to contact.
By selecting 'yes' here you give us permission to contact the teacher/school.
YesNo

Tell us more about your family and your interest in Lexicon School
What excites you most about Lexicon School? Why do you feel we are a good fit for your child?

Tell us about your family's educational journey. How have you been satisfied and dissatisfied with your child's education so far (if applicable)? What do you see as the role of a teacher in a child's education?

Please describe any social, emotional, or physical needs your child has.

How did you hear about Lexicon School?

Would you need financial aid in order to attend Acton Academy?
YesNo

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