INTAKE QUESTIONNAIRE 
PLAYING WITH WORDS

If you have already registered for the Playing with Words workshop, please submit this form prior to your first session. We ask these questions so we can better customize the class to fit your child's needs - thank you!

1. Has your child ever been tested for a speech or language delay?
2. Does your child currently receive any other speech-language services? Privately, through a school district or through the San Andreas Regional center?
5. I signed up for the Playing with Words workshop because: (select all that apply)

Your form has been submitted, thank you!