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

Thank you for taking an important step in better understanding your child’s growth and development! Pretend City Children’s Museum wants to invite you to complete  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 staff to review the ASQ-SE 2, send the results to your e-mail, and share an electronic copy of the results with the Help Me Grow, and OC Developmental Screening RegistryAs our gift, you will also receive a free admission ticket to Pretend City Children's Museum so you can continue playing and learning with your child. If we have any questions about your child's ASQ-SE 2, 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.