BWRSD Child Outreach Screening Request Form

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It is the goal of the Bristol Warren Regional School District and the RI Department of Education to screen 100% of children ages 3-5 annually.

Our free Child Outreach screenings provide families with an up-to-date check on their child's speech and language skills, social-emotional development, vision, hearing, and progress in the developmental areas of fine and gross motor skills, memory, etc. Much like a well-child visit with the pediatrician, children should participate in screenings annually at 3, 4, and 5 years old.

Please complete this form to request an Outreach Screening for your child. Screenings take place in the Early Childhood office at Hugh Cole Elementary School in Warren, with select dates available at Rogers Free Library in Bristol. Call 253-4000 x8052 or childoutreach@bwrsd.org with any questions.

***Please note that over summer break, there will be a delayed response to screening requests.***

Child's Name *

Child's Date of Birth *

YYYY

Parent/Guardian Name *

Phone Number *

Email Address *

Child's Primary Language *

English

Spanish

Other:

Do you have concerns or has anyone else shared concerns about your child’s development? *

Yes

How did you hear about the Child Outreach screening program? *

Childcare provider

Healthcare provider

Integrated preschool application

Public library

Word of mouth

Direct mail

BWRSD website

Other:

Child's Daycare or Preschool Program, if applicable

Questions, comments or concerns

Submit

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