1. I can read and understand English, and I have read and understand each and every question and instruction on this form, as well as my answer to each question.
2. Each and every question and instruction on this form, as well as my answer to each question, has been read to me in the -----language, a language in which I am fluent, by the person .......
-Check "1". Then, sign it for your child using this format: "your child's name/by parent: your name".