What is your child's name? (Last name, First name) *
Your answer
What is your child's birthdate? *
MM
/
DD
/
YYYY
My child is: *
Name of Parent or Guardian: (Last name, First name) *
Your answer
Home Phone Number: *
Your answer
Home address including postal code: *
Your answer
What is the name of your neighbourhood (For example: Castledowns, La Perle, Kirkness, etc.)? If you don't know, write "I don't know" for your answer. *
Your answer
How did you find out about Pre-Kindergarten? (For example: a website, through Early Intervention, from a friend, a doctor or health care provider). *
Your answer
Does your child have a diagnosis? (For example: speech or language delay, Autism Spectrum Disorder, Down's Syndrome, behaviour disorder). *
Your answer
Is your child awaiting any assessments or do you already have an assessment completed? *
What developmental concerns do you have for your child? Examples of developmental concerns are challenges with things such as speech, language, social interaction, or physical development. *
Your answer
Is there any other information you would like to provide?