Child Health Fair Registration Form

Registration Information
Parent/Guardian Name*

First NameLast Name
PhoneEmail
Phone Number*
Email Address*
example@example.com
Where do you live?*
YesNo
Developmental Screening
What is a Developmental Screening?

In a developmental screening, you will meet with a professional from the Early Years sector to complete an easy-to-use developmental tool that features a short list of “yes” or “no” questions about a child’s abilities. After completing the screening, you will receive additional tips of things you can do at home with your child or if interested, referrals to local community partners to support your child.

Important Note: Your child is required to be present for the developmental screening and we offer one appointment per child. If you wish to book appointments for multiple children, you will need to complete a different form for each child. Click here to open a new form.
YesNo
What is your child's name?*
0 - 18 Months18 - 30 Months30 Months - 6 Years
Please select a time slot:*
Will you be bringing more children with you? If yes, please detail their names and their respective ages below:
Will you be bringing more adults with you? If yes, please indicate how many:
Accessibility Support
YesNo
Please specify the language:*
YesNo
Public TransitOther
Should be Empty:

Registration Information