Developmental Screening Request Form
This form has been made available for families in the Caledonia Community Schools District to request a developmental screening for their child.

Please fill out the form below and someone from our staff at Duncan Lake Early Childhood Center will be in touch via email with directions for the next step.

We look forward to helping your family!
Child's Name (first & last) - one form per child *
Gender *
Birthdate *
MM
/
DD
/
YYYY
Parent/Guardian First & Last Name (primary contact) *
Home Address *
City & Zip *
Phone *
Email *
What prompted you to reach out to us? What is your primary concern? *
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