Pretend City Children's Museum
29 Hubble 
Irvine, CA 92618
949.428.3900
www.pretendcity.org

Because your child's first 5 years of life are so important, we want to help you provide the best start for your child. That’s why Pretend City Children’s Museum, through its child development initiative Good To Go From Head To Toe, provides the Ages & Stages Questionnaires: Social-Emotional, Second Edition (ASQ:SE-2) to help you keep track of your child's social and emotional development. The questionnaire may be provided for use at 2, 6, 12, 18, 24, 30, 36, 48, or 60 months of age. You will be asked to answer questions about some of your child's behaviors. The questionnaire includes questions about your child's ability to calm down, take direction and follow rules, communicate, perform daily activities (e.g., eating, sleeping), act independently, demonstrate feelings, and interact with others.

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:SE-2!



(put "0" if not premature)

By completing this questionnaire, you are giving your consent to allow our trained staff to review your child's ASQ-3 and mail you the results along with a list of fun activities for you to do with your child. As our gift, you will also receive one free admission ticket to Pretend City Children’s Museum so you can continue to play and learn with your child. If we have any questions about your child's ASQ-3, we will contact you by phone at the number you provided.

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.