FDLRS NEFEC Child Find Screening Registration
Please provide the following information about your child. Thank you!

*Required

Email address *
My child's full legal name (first, middle, last) is: * *
Your answer
My child is a: * *
My child's date of birth: *
Your answer
My child's race is:* *
My child's ethnicity is: * *
What language(s) are spoken in the home?* *
Has your child ever received any of the following services? *
Past-More than 1 year ago
Past-Less than 1 year ago
Currently receives
Never/Not applicable
Speech/Language Therapy
Occupational Therapy
Physical Therapy
Behavior (ABA) Therapy
Counseling
Early Steps (birth to 3rd birthday)
My child currently attends _______________. *
Name of preschool:
Your answer
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