Adopted: April 1994
Revised: October 2023
Download 501.3P - Conscientious Objection to Early Childhood Screening
To:
Early Childhood Screening
Independent School District 196
District Service Center
14301 Diamond Path
Apple Valley, MN 55124
Date:
For:
Child’s name Child’s age
In accordance with Minnesota state law, Independent School District 196 conducts
Early Childhood Screening to assist parents and communities in improving the health of Minnesota children and in planning educational and health programs. To ensure identification of risk factors that may influence learning, screening requirements
include the following areas:
• immunization assessment
• developmental screening to assess development of cognitive, fine and
gross motor skills, speech and language, social-emotional behavior and
self-help skills
• hearing and vision
• height and weight
• health history
• summary interview
I understand the purpose of Early Childhood Screening and due to my conscientiously held beliefs object to having my child screened in all of the
areas listed above.
OR
I understand the purpose of Early Childhood Screening and due to my conscientiously held beliefs object to having my child screened in the following areas specified here:
Signed Relationship to the child
Relationship to the child
Child Study File (if one exists) Cumulative Folder Other