Registration - ESFRA/Dalhousie Screening
Parent/Guardian Information
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By selecting a ticket and completing this registration for the PLS-5/K-SEALS screening, I am giving permission for my child to be screened for "school readiness and hearing" by students from Dalhousie University's School of Human Communication Sciences & Disorders in conjunction with ESFRA.  The information gathered on this form is for the sole purpose of notifying parents/guardians of any needs requiring further testing.   Any questions and/or concerns please contact Tracy Cowan, Parenting Journey Home Visitor @ 902-827-2311 or 902- 476-0642.
Parent/Guardian's Name (Primary contact) *
Parent/Guardian's Email Address *
Parent/Guardian's Address (Street Address) *
Parent/Guardian's Address (Town) *
Parent/Guardian's Address (Postal Code) *
Select the date & time corresponding to your ticket. (Screening time is approx. 2hrs.) *
Would you like to receive our newsletter by email? *
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