Fillable Screening Exit Signature Form Childs Last Na me

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Screening Exit Signature Form Childs Last Na me

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The Screening Exit Signature Form Childs Last Na me form is 1 page long and contains:

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File type: PDF

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Regional Office of Education #08
27 S. State Ave., Suite 101, Freeport, IL 61032
Phone: 815.599.1408 Fax: 815.297.9032
www.roe8.com
Screening Exit Signature Form
Child’s First Name
Child’s Last Na
me
I acknowledge that I met with screening personnel and that when a preschool opening for my child exists, I
will be contacted by the school district. Should there be additional steps in the screening process, I have been
notified of the process and a contact person to follow up with.
Parent/ Guardian Name (Print)
Signature of Parent/ Guardian
If you have further questions please call:
School District Contact Name // Title
Phone Number
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Screening Exit Signature Form Childs Last Na me

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Completed 25 May 2021

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