Student Information First Name* Last Name* Preferred Name (If different from First Name) Date of birth Day12345678910111213141516171819202122232425262728293031MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberYear20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 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 Day12345678910111213141516171819202122232425262728293031MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberYear2020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990 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 Lexicon School? YesNo
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