Screening Permissions
Please fill out the requested information and submit when completed.  O'Fallon CCSD #90 collects written permission from all families to conduct developmental and social emotional screenings on all children birth to age 5.  You will once again be asked to click permission on the Ages and Stages Website (which is in addition to O'Fallon CCSD #90).  A staff member will be in contact with you once the screenings have been completed.  
Sign in to Google to save your progress. Learn more
Email *
Clear selection
Child's Name *
Child's Date of Birth *
MM
/
DD
/
YYYY
Parent's Name and Phone Number *
I hereby authorize certified personnel of O'Fallon CCSD #90 Early Learning Programs to administer a social-emotional screening to my child for the purpose of providing appropriate services.  I understand the results of the screening will be shared with me.                                 *
I hereby authorize certified personnel of O'Fallon CCSD #90 Early Learning Programs to administer a developmental screening to my child for the purpose of providing appropriate services.  I understand the results of the screening will be shared with me.                                 *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of O'Fallon School District 90. Report Abuse
Google Forms