Preschool Screening Sign-up Form
YOUR CHILD MAY QUALIFY IF:
-- He/She is a Campbell County Schools resident and...
-- He/She is 3 or 4 years old and displays difficulty in speech and/or problems attaining developmental skills that are needed to be successful in school
-- He/She is 4 years old by August 1st and the family qualifies financially

After submitting this form a letter will be mailed with date/time/location your child is scheduled to be screened
Child's Last Name *
Your answer
Child's First Name *
Your answer
Child's Birthday *
MM
/
DD
/
YYYY
Physical Address: Street Number and Name *
Your answer
Physical Address: City and Zip *
Your answer
Mailing Address (PO Box Number)
Your answer
Mailing Address (PO Box City and Zip)
Your answer
Parent / Guardian: First Name *
Your answer
Parent / Guardian: Last Name *
Your answer
Parent / Guardian: Phone *
Your answer
Parent / Guardian: Email *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Campbell County Board Of Education. Report Abuse - Terms of Service