Register Interest

All information is strictly confidential and used only for Lighthouse planning purposes

Parents Name(s)

Address

Postcode

Contact Number

Email address:

Name of child

Date of Birth

Male/Female

Does your child have a diagnosis?

Please state

Does your child have a Statement of Special Educational Needs or FFI funding?

FFI level:

Current School Year (e.g. Year 5)

What is your child’s current provision? e.g. mainstream with or without support; SILC; DSP; ABA; Home ed.

What secondary provision is currently available to you? Please also name your local authority.

Which other interventions/therapies does your child access? Please select
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Any other comments/information