Registration- Language Stimulation Questionnaire anglais - Stimulation du langage (2021) Informations générales et coordonnées first and last name of the child * gender * Girl Boy Age at registration (month and/or year) * date of birth * Full name of parent completing form * Other parent's full name * Complete adress * #, rue et ville e-mail address * Phome number * registration date * For which service are you registering? * Tuesday (only in french) - Saint-Zotique - schedule to be determined according to level Saturday - Vaudreuil-Dorion - schedule to be determined according to level Habiletés de communication et de langage * 2-part directions: give me the ball and the duck… / put the duck in the basket My child shows interest in other people * Yes No CommentsComments My child demonstrates an interest in communicating * Yes No CommentsComments My child uses many ways to be understood (pointing, gestures) * Yes No CommentsComments My child starts to say 2 words together (e.g. more cookie) * Yes No CommentsComments * Yes No CommentsComments Simple questions: What, Where, Who, Whose, What is he doing, Which one / Concepts: words of dimension, quantity, location, color, quality, space, time, etc. My child expresses their desires and needs verbally * Yes No CommentsComments My child uses a variety of words (people, objects, actions, adjectives) * Yes No CommentsComments My child makes sentences of 3 to 4 words * Yes No CommentsComments My child pronounces quite well most words of 2 syllables * Yes No CommentsComments My child understands 2-part directions and different concepts * * Yes No CommentsComments * 2-part directions: give me the ball and the duck… / put the duck in the basket My child comments, asks questions, answers questions * Yes No CommentsComments My child uses an accurate and varied vocabulary * Yes No CommentsComments My child makes sentences of 6 words or more * Yes No CommentsComments My child is easily understood by family * Yes No CommentsComments My child understands long and complex sentences or directives * Yes No CommentsComments My child participates in conversations, tells stories * Yes No CommentsComments My child uses a specific vocabulary, categories of words * Yes No CommentsComments My child is easily understood by others (non-family) * Yes No CommentsComments My child speaks fluently, without hesitation * Yes No CommentsComments My child conjugates verbs well when speaking * Yes No CommentsComments My child maintains a conversation for several speaking rounds on the same topic * Yes No CommentsComments My child tells a story with complex sentences, while respecting the order of events * Yes No Comments My child understands more complex and precise instructions such as "circle the smallest square" * Yes No Comments My child makes complex associations between different concepts * Yes No Comments Other comments or details Consentement An email confirming of the form will be sent to you. A Case Worker will contact you as soon as possible to discuss your needs and complete your child's registration for the service. * I understand MEMBERSHIP : Become a member of the Maison de la Famille and contribute to its development! The membership card gives you access to all of our free or reduced rate services and allows you to participate in the AGM. I would like to become a member at a cost of $ 10 I would like to become a member for $10 NEWSLETTER : Receive our latest news about our services and activities by subscribing to the monthly newsletter of the Maison de la Famille. Subscribe to the newsletter PHOTO AUTHORIZATION: I authorize the release of any image or video of my minor child, in whole or in part, individually or with other images or videos on The Maison de la Famille website and other official websites, as well as for media purposes, including promotional presentations and advertising campaigns. I also authorize the distribution and use of any media material created by my child. I am over 18 years of age and am the parent or legal guardian of the child. * Yes No I authorize the Maison de la Famille de Vaudreuil-Soulanges and the CISSSMO-CLSC de Vaudreuil-Soulanges to share the information concerning my child that is necessary for the language stimulation workshops Yes No Captcha Si vous êtes un humain, ne remplissez pas ce champ.
