Parental Consent to


Pathways Pediatric Services is a private business working with multiple Early Childhood Services Operators (ECS).

It is the mission of our working ECS partners to responsibility administer funding from Alberta Learning to help children develop age-appropriate skills to encourage later school success in areas such as talking, listening, playing, moving, learning, and participating. We work closely with families and ECS programs to create developmentally appropriate and measurable goals that are tailored to each child’s strengths and needs.

Alberta Education Funding Programs:

Program Unit Funding (PUF)

Alberta Education provides Program Unit Funding (PUF) to assist children between the ages of 2 years, 8 months and less than 6 years of age (as of September 1 of the school year) with severe delays within a school or community ECS program.

Mild-Moderate Funding

Alberta Education provides Mild-Moderate funding to assist children between the ages of 3 years, 8 months and less than 6 years of age (as of September 1 of the school year) with mild to moderate delays within a school or community ECS program.

Pathways and Lead Foundation create flexible, goal-focused programs to support these children in experiencing success within their family’s chosen ECS program.

Note: Your child must be a minimum of 2 years, 8 months as of September 1 of the school year in order to access Alberta Education funding. If your child is not 2 years, 8 months please do not complete this form – give us a call regarding private services 403-455-4072

Parental Consent to Screening/Assessment Form

Your agreement of this screening and/or assessment is acknowledged by signing this parental consent form. Your signature indicates:

  • I consent to the participation of my child in a screening and/or assessment of their speech-language (ex: speech sounds, expressive language, etc.) and/or occupational therapy (ex: fine motor, sensory, etc.) skills.
  • I understand that assessment results may be shared with preschool staff and Pathways working partners as it pertains to my child’s programming.

If your child has been seen by other professionals, please provide the following information:

Personal Information

School Information

Parent/Guardian Information

Alternate Contact for Parent/Guardian (if different from above)

If your child requires further involvement by a Pathways therapist, you will be notified regarding the next steps in the process.

You and your child’s participation in this project are voluntary.

Pathways Working Partnerships

Pathways works with Early Childhood Service Operators (ECS) to provide a comprehensive learning team which includes a Certified Teacher, and if necessary any or all of the following: Speech-Language Pathologist, Occupational Therapist, Physical Therapist, Psychologist. Pathways therapists collaborate with the Early Learning Coordinators (ELC's) from our partner agencies to develop a program focused specifically on the individual needs of each child. It is the ELC's responsibility to ensure that the funding provided from Alberta Learning Services is contributing to the healthy development of the children in our communities prior to entering grade school.

I consent for Pathways to share information related to my child with its working partner agencies and professionals.