Regional Office of Education #08
27 S. State Ave., Suite 101, Freeport, IL 61032
Phone: 815.599.1408 Fax: 815.297.9032
Screening Exit Signature Form
Child’s First Name
Child’s Last Na
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
click to sign
click to edit