Request a Screening Appointment
This form will add your information to our list of students requesting a screening appointment.  The screening is the first step to becoming eligible to enroll at Sunnybrook School District 171l. *NOTE: You must be a resident of District 171.
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1. Child's Name (First and Last) *
2. Mother's Name (First and Last) *
3. Father's Name (First and Last) *
4. Child's Date of Birth *
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5. Address (include apartment number if applicable);  City, State, Zip Code  *
6. Preferred Phone Number *
7. Alternate Phone Number (if applicable)
8. Email Address *
9. Child's Gender *
10. What is your native language? *
11. What language is spoken in the home?
12.   Do you have any concerns for your child? (speech, social-emotional, general development, etc.) *
13.  Names and ages of child's siblings:
14.  Has your child ever attended a preschool or daycare program?
15. If yes, Please enter the name of the program
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