Central Parkland Parent Link Network

c/o Lacombe & District Family and Community Support Services

(serving Wetaskiwn, Ponoka, Rimbey, Lacombe and Blackfalds)

Cora Hoekstra, Director

#201, 5214 - 50 Avenue

Lacombe, AB  T4L 0B6

403-782-6637 ext 307

choekstra@lacombefcss.net

www.centralparklandparentlink.ca



(put "0" if not premature)

For ASQ-3™ English

For ASQ:SE-2™ English

I have read the provided information about the Ages & Stages questionnaires, and I wish to have my child participate in the online screening program. I will fill out the questionnaire about my child's development and promptly submit the completed questionnaire through this Family Access online questionnaire completion system.

Note: By clicking "Submit", you are agreeing to both our Family Access End User License Agreement and any other consent or authorization information outlined on this page.