Apply – Light A Match

Light-A-Match Nigeria

Light-A-Match (LAM) Nigeria is a not for profit initiative that runs under the registered Non Governmental Organization, Jacobs Child Foundation. Vision: The vision of Light-A-Match is to identify, prepare and reward young change agents within the Nigerian community. It is targeted at children who are “coming of age”. Children who are on the cusp of being able to exercise their right to vote. (Specifically children between the age bracket of 14-18 years.) The next LAM Academy will run at the LAM Centre in Lekki Phase One, Lagos State. Should you want to enroll your child for this cohort, please fill the below form with their details.

Student's First Name

Student's Last Name

DOB

Place of Birth

Phone

Gender

Male Female

Address

City

Province/Region

Country

Grade Level

School Currently Attending*

School Address

School Address 2

City

Parent/Guardian's First Name - Primary

Parent/Guardian's Last Name - Primary

Occupation - Primary PG

Primary PG Mobile number

Primary PG Email

Parent/Guardian Name - Secondary

Occupation - Secondary PG

Secondary PG Mobile number

Secondary PG Email

Health History

Emergency Contact Person First Name

Emergency Contact Person Last Name

Emergency Phone Number

Child ID (coloured) *

I agree to the terms & conditions provided by the academy. I also certify that all information in this form is true and accurate.

Parent/Guardian Signature

Date Signed