Timberline Learning Center970-453-9656[email protected]P.O. Box 3098Breckenridge, Colorado 80424
Child Date of BirthFormat: yyyy-mm-dd Child DOB you entered is in the future, are you sure of that? (Please correct the date before proceeding to the next step). Please enter your child's DOB and not the screening date or today's date (Please correct the date before proceeding to the next step). Child DOB you entered is not valid, please format the date like this: YYYY-MM-DD
Weeks Premature (put "0" if not premature)
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I have read the information provided about the Ages and Stages Questionnaires, Third Edition (ASQ-3), and I wish to have my child participate in the screening/monitoring program.
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