Hello Playgroup Caregiver-

 

Below you will find a link to complete the Ages and Stages Questionnaire online screening to help keep track of your child's development as part of our Playgroup!   

 

You will be asked to answer questions about some things your child can and cannot do.  The questionnaires include questions about your child's communication, gross motor, fine motor, problem-solving, personal-social skills, and social-emotional skills.

 

If you are completing this as a grandparent or other caregiver that is not a problem, just indicate as such as you complete it.

 

 

​The Early Childhood Team will follow up with you in the coming days regarding the results of your screening and additional information about future playdates!

 

Child Date of Birth

Month Day Year

MM 01 02 03 04 05 06 07 08 09 10 11 12 DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YYYY 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024

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: MM-DD-YYYY

Weeks Premature
(put "0" if not premature)

Screening Date Options

For ASQ-3™ English

Screening Date

List others assisting with completion of the questionnaire

For ASQ:SE-2™ English

Screening Date

List others assisting with completion of the questionnaire

I have read the provided information about the Ages & Stages questionnaires, and I wish to have my child participate in the online screening program. I will fill out the questionnaire about my child's development and promptly submit the completed questionnaire through this Family Access online questionnaire completion system.

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.