Center for Community ILP907-966-4231gtrujillo@cfc.org700 Katlian StSuite BSitka, Alaska 99835cfc.org
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)
I give consent for the Early Learning Program to screen my child named above. I understand that if my child shows a questionable screening r4esult, that I may be offered a child developmental evaluation.
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