Pre-K Developmental Screening Consent Form

Pre-K Developmental Screening Consent Form — Form Fields

This education template includes 11 fields. Parents consent to their pre-kindergarten child's developmental screening for early identification of learning needs. Free to customize and use on ZenBuild.

• Child's Full Name (text, required)
• Date of Birth (text, required)
• Parent or Guardian Name (text, required)
• Email Address (email, required)
• Phone Number (text, required)
• Child's Current Preschool or Program (text, optional)
• Screening Areas to Include (dropdown selection, required) — options: Speech and Language, Motor Skills, Cognitive Development, Social-Emotional, All Areas
• Parent Observations or Concerns (long text, optional)
• Primary Language Spoken at Home (dropdown selection, required) — options: English, Spanish, French, Mandarin, Arabic, Other
• I consent to this developmental screening (checkboxes, required)
• I consent to share results with the school team (checkboxes, required)