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Peoria Park District Electronic Forms

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Peoria PlayHouse Screening sign ups

Sunday, September 25th from 12:00pm-4:00pm

Child & Family Connections #14 will be providing early childhood screening for children birth to age 5.
This will be a quick 20-30 minute screening of your child.

If you have any questions, feel free to contact us.
Shannon Dault
309.360.9743 | sdault@cicfc.org

Parent / Guardian Name(Required)
Best form of contact(Required)
Please choose from the following:(Required)
Address
Child's Name(Required)
Child's Date of Birth(Required)
Currently in foster care?(Required)
Please select a time slot that works best for you(Required)
We'll do our best to accommodate your first choice time slot, but with limited slots and days available, please choose an alternate time slot(Required)