Child Development Day Sign-up January 16, 2020
Parents will be asked to fill out a questionnaire regarding their child's development while their child participates in a play based universal screening, including vision screening. Specialists in the early childhood field will be available to address any questions or concerns raised by parents.

Please complete the form below to secure your spot in one of our three screenings offered for the 2019-2020 school year!

PRESCHOOL CHILD DEVELOPMENT SCREENING will provide families with the opportunity to
learn about:
· The level of their child’s development through participation in an educational screening
· Available services in the community for families and young children
· Normal child growth and development of children ages three to five years

Contact Mr. Matthew Sherwood at (715)884-2517 with any questions.

Child's First Name *
Your answer
Child's Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Parent/Guardian *
Your answer
Phone Number *
Your answer
Address *
Your answer
Email Address *
Your answer
Available Time Slots *
Where does the child spend the majority of their day? *
Questions or Concerns?
Your answer
Does your child currently receive services through a clinic, hospital, or agency?
Your answer
Submit
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