*Child must be at least three years old on September 1.
Is your child speaking in 4-5 word sentences?
Provide an example:
Does your child follow simple directions given by an adult?
Explain, if needed:
Does your child have any physical restrictions?
If yes, please describe:
Is your child toilet trained?
*children must be independent in the bathroom.
Does your child have opportunities to play with other children?
Do you have concerns about your child's play or social skills?
Does your child have difficulty separating from familiar adults?
The following information about my child may be helpful to the decision-making process:
I give my permission for the Learning Together team to use information on this form in the decision making process related to participation in the
Learning Together Program. I understand that this information will be kept confidential and cannot be read by anyone other than the
Harford County Public School personnel who have a legitimate educational interest. I am aware that this information may not be sent to anyone
outside of Harford County Public Schools without my written permission and that I may request that this information be removed from my child’s records
if it is inaccurate, misleading, or otherwise in violation of the privacy or other rights of my child. I am also aware that I may request a
copy of this completed form for my own records.
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