Lakeville Area Schools Early Childhood Screening Request

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Please fill out this brief form to provide us with basic information for your child's Early Childhood Screening Appointment. If you have more than one child who requires screening please use the link at the end of this form to submit another response. After filling out this form please enroll your child in Early Childhood Screening following the directions on our website or the link you receive in an email after completing this form.

Email *

Child's Last Name *

Child's First Name *

Child's Date of Birth *

YYYY

Contact Phone Number *

A copy of your responses will be emailed to the address you provided.

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