ABC Head Start Society
Jerry Forbes Centre
12122 68 ST NW
Edmonton, Alberta T5B 1R1

Dear Parent/Guardian, 

Welcome to part two of the Head Start Program application!

In order to complete your application, please fill out the following questionnaire about your child. 

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Because your child's first 5 years of life are so important, we want to help you provide the best start for your child. You've been invited to participate in the Ages & Stages Questionnaires, Third Edition (ASQ-3), to help you keep track of your child's development. The questionnaire may be provided every 2-, 4- or 6-month period. You will be asked to answer questions about some things your child can and cannot do. The questionnaire includes questions about your child's communication, gross motor, fine motor, problem solving, and personal social skills.

Please enter your child's birth date and the number of weeks he or she was born premature below to start the screening. Please note that the information you enter into this website is secure and cannot be seen or accessed by anyone other than the program employees who have invited you to participate in this screening.

We look forward to your participation in ASQ-3!

(put "0" if not premature)

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.

The information provided in this document is true, correct and complete. I have identified all parents and legal guardians for this child. The individuals identified in the “parent/legal guardian” section have the right to view child information and make educational decisions for this child, unless otherwise indicated here and supported with legal documentation. Further, I recognize that it is my responsibility to notify ABC Head Start Society should the above information change.

In accordance with the Freedom of Information and Protection of Privacy Act (FOIP), I accept ABC Head Start Society is authorized and required under the provisions of the School Act and its regulations to collect, use and disclose personal information that is necessary to provide educational programming and ensure a safe and secure environment for children.







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.